Gastrointestinal Stromal Tumor

Gastrointestinal stromal tumors are a rare type of tumor disease in the digestive system. It often affects people of advanced age. On average, GIST (gastrointestinal stromal tumors) is diagnosed at the age of 60. The number of new cases of these malignant connective tissue tumors is comparatively low in Germany with 800 to 1200 cases per year.

What is a gastrointestinal stromal tumor?

GIST (gastrointestinal stromal tumors) is a collective term for various forms of cancer that express themselves through the development of soft tissue or soft tissue tumors. In contrast to other carcinomas in the digestive tract, cancer cells develop in the connective or supporting tissue.

In carcinomas, the covering tissue, primarily the mucous membranes, of the corresponding organs is affected. This differentiation of the form of cancer is important for the correct therapeutic approach to treatment. The tumors are particularly often localized in the stomach and small intestine, less often in the esophagus, large intestine and rectum.

In very rare cases, the tumors described can also occur outside the abdominal cavity; these are “extragastrointestinal stromal tumors” (EGIST). Extremely few patients can also be affected by another special form, “gastrointestinal autonomic nerve tumors” (GANT).

Causes

By genetic mutations there is a change in the so-called “KIT receptor.” The receptor proteins no longer function correctly, are either permanently active or present in too large quantities and give off false signals. This in turn leads to a much increased cell formation and uncontrolled growth of cells that give rise to gastrointestinal tumors.

GIST can be differentiated from other forms of cancer by detecting the mutated KIT receptors described. However, there is also another form of mutation that triggers GIST. Here the gene of the “PDGF receptor” is affected. Similar to the KIT receptor, the processes of cell growth and / or cell division take place here.

The change in this genetic blueprint leads to an uncontrolled proliferation of cells, the cause of cancer. “Wild-type GIST” is another, rare form of disease, in which neither mutations at the KIT nor at the PDGF receptor can be detected.

Symptoms, ailments & signs

GIST disease usually manifests itself with diffuse symptoms such as abdominal pain and / or abdominal pain, a feeling of fullness or digestive disorders. Internal bleeding from a tumor can also lead to anemia and the associated fatigue.

Depending on the location of the malignant tumors, swallowing difficulties (esophagus), an early feeling of fullness (stomach), black stools due to blood in the intestinal area or weight loss due to the withdrawal of nutrients can indicate GIST. Since this is a rarely occurring cancer, the symptoms initially indicate more obvious indications. A correct diagnosis is usually made late.

Diagnosis & course

The unspecific symptoms of this tumor disease make a reliable and quick diagnosis difficult. The disease is often discovered accidentally during other routine examinations such as an endoscopy or other surgical procedure. The severity of the disease can be interpreted based on the strength of the symptoms.

Larger tumors or the formation of daughter tumors indicate a more severe course, as does a high rate of cell division of the cancer cells. Only then do clear symptoms of the disease usually appear. As the tumors increase in size, abdominal bleeding due to tumor perforation or gastrointestinal obstructions (occlusions of organs) can occur.

This life-threatening situation can only be remedied through an emergency operation, which then leads to the ultimate diagnosis of the disease. If metastases occur, complete healing is often hardly possible. Nevertheless, there is the option of drug treatment in combination with surgical interventions to contain the disease to such an extent that it is still possible to live with this disease. However, if the diagnosis is made early, the full chances of recovery are very positive.

Complications

Since this disease is a tumor disease, it is also fraught with the usual symptoms and complications of a tumor. Without treatment, the tumor will in most cases spread to other regions of the body and can affect healthy tissue. Under certain circumstances, the patient’s life expectancy may then be reduced.

Those affected suffer from severe pain in the stomach and abdomen and often from a feeling of fullness. This results in a small amount of food being consumed and underweight. There are also general digestive disorders and severe fatigue. The patients seem exhausted and no longer take an active part in life. Furthermore, swallowing difficulties can occur, which considerably reduce the quality of life.

It is not uncommon for depression or other psychological disorders to develop. The everyday life of the person concerned is also made more difficult. The earlier the disease is diagnosed, the lower the risks of the disease. A surgical intervention can lead to a positive course of the disease. As a rule, there are no further complications with the treatment itself. It cannot be universally predicted whether life expectancy will be restricted.

When should you go to the doctor?

If you experience pain in the stomach, a recurring feeling of fullness, or a feeling of pressure in the chest, a doctor should be consulted. If there are changes in digestion, nausea or vomiting, a doctor must be consulted. A doctor is needed in the event of abdominal discomfort, diarrhea or constipation. A rapid heartbeat, an increase in blood pressure, sweats or inner restlessness should be clarified by a doctor. If food intake is reduced, weight loss sets in, or general weakness occurs, a doctor should be consulted.

If you are tired, have poor appetite, have reduced performance or have difficulty swallowing, a doctor’s visit is necessary. If you notice an increase in symptoms or if the existing pain continues to spread, you should consult a doctor as soon as possible. If the person concerned suffers from a vague feeling of illness, inexplicable fears or a circulatory disorder, he should consult a doctor. Regular participation in cancer screening examinations is generally recommended from middle adulthood.

Since early detection of gastrointestinal stromal tumors can take place in these check-ups, an annual check-up should take place. If the person concerned suffers from mood swings, irritability or apathy, a visit to a doctor is also advisable. If participation in social life drops, professional or sporting activities are no longer carried out as usual or if there is fatigue, it is advisable to consult a doctor.

Treatment & Therapy

The earlier the diagnosis of GIST is made, the better the chances of recovery for those affected. The primary tumors that have arisen can often be completely removed through a surgical procedure. If no metastases have occurred, the chances of recovery are very good.

If primary tumors occur in combination with other overgrown daughter tumors, treatment becomes correspondingly more difficult, and an increased relapse rate must also be expected. The size of the tumor and its location as well as the rate of cancer cell division are suspected as triggering factors for a relapse or the formation of metastases.

Even with successful removal of a primary tumor, the cancer may return. Under certain genetic conditions in the affected patient, the active ingredient imatinib can lead to growth retardation or even a stoppage of the growth of the tumors.

Medicines with this active ingredient do not change the causative mutation, but they can intervene in a regulating manner, so that the uncontrolled cell growth can be stopped or reduced. Whether and at what point in time the drug can be used can only be decided through individual advice from a doctor who specializes in GIST.

Outlook & forecast

In the case of gastrointestinal stromal tumors, the prospect of relief or cure is tied to the point in time at which the tumor is discovered and treatable. Without medical care, the average life expectancy will be shortened. The cancer cells spread in the organism and lead to the premature death of the person affected.

The prognosis when using treatment is tied to the stage of the disease. At an advanced stage of the disease, further metastases have often already formed in various places in the organism. The cancer has spread and can no longer be adequately treated.

In these cases, medical care is geared towards alleviating the existing discomfort and reducing pain. A particularly good prognosis is given to patients in whom the tumor was discovered in the early stages. In a surgical procedure and a subsequent cancer therapy, the diseased tissue can often be completely removed. This increases the chances of a later healing.

The difficulty with the disease lies in the time of diagnosis. In the early stages, it is usually an incidental finding. If symptoms arise, the tumor is usually in a middle or advanced stage of the disease. In addition, despite healing, a tumor can develop again later in life.

Prevention

So far, no identified factors for the development of GIST are known. Conclusions about a disposition for older people can only be drawn from the diagnosis, which often occurs in old age. In addition, men are more likely to have the disease than women.

Of course, a healthy lifestyle is always a precautionary advice, but the vague factors “age” and “gender” cannot be influenced here. Real risk factors are therefore not known.

Aftercare

As a rule, the person affected has very few or no follow-up measures or options available for this tumor. First and foremost, early detection and diagnosis must take place so that there are no further compilations and other complaints. The earlier the tumor is recognized, the better the further course is usually.

Self-healing cannot occur with this disease, so that the person affected is dependent on treatment in any case. Even after the tumor has been successfully removed, the person concerned is dependent on regular examinations by a doctor. This means that further tumors or recurrences can be detected early and then treated as well. In most cases, the tumor itself is removed by surgery.

The affected person should definitely rest after such an operation and continue to take care of his body. Here, exertion or other stressful or physical activities are to be avoided. Help and care from one’s own family is also often necessary. In many cases, this tumor has a negative impact on the life expectancy of the person affected.

You can do that yourself

The gastrointestinal stromal tumor is a malignant cancer that the patient cannot treat himself. A close-knit therapy and regular check-ups under specialist supervision are absolutely necessary so that the disease does not lead to the death of the patient.

Those affected can, however, support the positive course of therapy through their own behavior. Basic requirements are a positive attitude towards life and the will to conquer the disease. In addition, there is a trusting and open relationship with the treating physicians and a willingness to consistently apply and follow the measures required in the therapy.

Outside of purely medical therapy, the patient has the opportunity to maintain or improve the general condition of his body. The basis of these improvements is to renounce all habits that weaken the body or deprive it of energy. First and foremost, it is about avoiding addictive substances such as alcohol and nicotine, but also caffeine and unhealthy foods to a greater extent. If the body is no longer burdened by these things, more energy remains for the healing process.

Strengthening the cardiovascular system and general fitness is also an important point. Those affected should incorporate a light but regular sport or exercise program into their everyday life, preferably in consultation with a doctor or a physiotherapist. A healthy lifestyle is conducive to healing.

Gastrointestinal Stromal Tumor