Gastrointestinal Stomach Tumour

Who Does Gastrointestinal Stomach Tumour Affect?

Currently, there are very few known risk factors for gastrointestinal stomach tumours (GISTs).

These tumours can occur in people of any age, but they are rare in people younger than 40 and are most common in people older than 50.

Most GISTs are sporadic (not inherited) and have no clear cause. In rare cases, though, GISTs have been found in several members of the same family. These family members have inherited a gene mutation (change) that can lead to GISTs.

What Causes Gastrointestinal Stomach Tumour?

Researchers do not know exactly what causes most gastrointestinal stomach tumours (GISTs). But great progress has been made in learning how certain changes in DNA can cause normal cells to become cancer cells.

DNA is the chemical in our cells that makes up our genes, which control how our cells function. We usually look like our parents because they are the source of our DNA. But DNA affects more than just how we look.

Symptoms of Gastrointestinal Stomach Tumour

People with a GIST often do not experience any specific symptoms or signs. When symptoms do occur, they may be vague. Or, the cause of a symptom may be a different medical condition that is not a tumour.

Pain or discomfort in the abdomen
A mass in the abdomen that you can feel with your hand
Bowel obstruction
Nausea and vomiting
Vomiting blood
Blood in the stool
Fatigue due to anemia, which is a low red blood cell count and is often caused by bleeding in the GI tract

People often do not experience any particular symptoms with GIST. It is often discovered during a medical evaluation due to chronic anemia, abdominal pain, or gastrointestinal bleeding, or imaging tests done for another reason.

How is Gastrointestinal Stomach Tumour Diagnosed?

Doctors use many tests to find or diagnose, a GIST. Your doctor may consider these factors when choosing a diagnostic test:

The type of tumour suspected
Your signs and symptoms
Your age and general health
The results of earlier medical tests

In addition to a physical examination, the following tests may be used to diagnose GIST or determine the best treatment plan. Not all tests listed below will be used for every person.

Computed tomography (CT or CAT) scan. A CT scan is often the best test to diagnose and monitor a GIST. A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumours.
Endoscopy/endoscopic ultrasound. An endoscopy allows the doctor to see the inside of the stomach or large bowel. The patient may be sedated. Sedation is giving medication to make a patient more relaxed, calm, or sleepy. With an upper endoscopy, the doctor inserts a thin, lighted tube called a gastroscope through the mouth, down the esophagus, and into the stomach and upper small bowel. With lower endoscopy, the scope is inserted through the anus to visually evaluate the rectum and colon. If abnormal areas are found, the doctor can remove a sample of tissue and check it for evidence of cancer (see "Biopsy," below).
Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can be used to measure the tumour’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow.

If a tumour (also called a mass or nodule) is found, the doctor will also do tests to learn if it is cancerous. For most types of tumours, a biopsy is the only sure way for the doctor to know if an area of the body has cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

Biopsy. Your doctor may recommend a biopsy if a mass suspected of being a GIST is found. A biopsy is the removal of a small amount of tissue for examination under a microscope. The type of biopsy performed will depend on the location of the tumour. Other tests can suggest that a tumour is present, but only a biopsy can make a definite diagnosis.
Tumour pathology. A pathologist makes a diagnosis of GIST by looking at the shape and appearance of tumour cells, doing tests for a protein called KIT and other tumour markers, and finding the mitotic count (a way of measuring how many cells are actively dividing.
Molecular testing of the tumour. Your doctor or pathologist may recommend running additional laboratory tests on a tumour sample to identify specific genes, proteins, and other factors unique to the tumour. Results of these tests can help determine your treatment options.
Positron Emission Tomography (PET) or PET-CT scan. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

After your diagnostic tests, your doctor will review all of the results with you. If the diagnosis is GIST, some of these results also help the doctor describe the tumour.

Gastrointestinal Stomach Tumour Staging

Staging is a way of describing where the tumour is located, or if it has spread to another part of the body from where it started. If this happens, it is called metastasis. Doctors may also do tests to learn which treatments could work best.

The stages for gastrointestinal stromal tumours (GIST) range from I (1) through IV (4). As a rule, the lower the number, the less cancer has spread. A higher number, such as stage IV, means cancer has spread more. And within a stage, an earlier letter means a lower stage. Although each person’s cancer experience is unique, cancers with similar stages tend to have a similar outlook and are often treated in much the same way.

There are 2 different stage grouping schemes, depending on where cancer starts:

The stomach or the omentum (an apron-like layer of fatty tissue that hangs over the organs in the abdomen)
The small intestine, esophagus, colon, rectum, or peritoneum (a layer of tissue that lines the organs and walls of the abdomen.)

GIST that starts in the stomach or the omentum:

Stage I

A- The tumour is:

No more than 2 cm across (T1) OR
Larger than 2 cm but not more than 5 cm across (T2). Cancer has not spread to nearby lymph nodes (N0) or to distant sites (M0). The mitotic rate is low.

B- The tumour is larger than 5 cm but not more than 10 cm across (T3). Cancer has not spread to nearby lymph nodes (N0) or to distant sites (M0). The mitotic rate is low.

Stage II

The tumour is no more than 2 cm across (T1). Cancer has not spread to nearby lymph nodes (N0) or to distant sites (M0). The mitotic rate is high.

Stage III

A- The tumour is larger than 5 cm but not more than 10 cm across (T3). Cancer has not spread to nearby lymph nodes (N0) or to distant sites (M0). The mitotic rate is high.

B- The tumour is larger than 10 cm across (T4). Cancer has not spread to nearby lymph nodes (N0) or to distant sites (M0). The mitotic rate is high.

Stage IV

The tumour is any size (Any T) AND it has spread to nearby lymph nodes (N1). Cancer has not spread to distant sites (M0). The mitotic rate can be low or high.

GIST of the small intestine, esophagus, colon, rectum, or peritoneum:

Stage I

The tumour is:

No more than 2 cm across (T1) OR
Larger than 2 cm but not more than 5 cm across (T2).

Cancer has not spread to nearby lymph nodes (N0) or to distant sites (M0). The mitotic rate is low.

Stage II

The tumour is larger than 5 cm but not more than 10 cm across (T3). Cancer has not spread to nearby lymph nodes (N0) or to distant sites (M0). The mitotic rate is low.

Stage III

A- The tumour is no more than 2 cm across (T1). Cancer has not spread to nearby lymph nodes (N0) or to distant sites (M0). The mitotic rate is high.

B- The tumour is larger than 2 cm but not more than 5 cm across (T2). Cancer has not spread to nearby lymph nodes (N0) or to distant sites (M0). The mitotic rate is high.

Stage IV

The tumour is any size (Any T) AND it has spread to nearby lymph nodes (N1). Cancer has not spread to distant sites (M0). The mitotic rate can be low or high.

Non-Surgical Treatment for Gastrointestinal Stomach Tumour

Treatment for your condition can begin immediately and can include:

Pain Medication - to treat pain or discomfort including nonsteroidal anti-inflammatory medications (NSAIDs) can relieve some
Inflammation Medication - may be prescribed to alleviate swelling including antibiotics for infection control
Aspiration - may be used to remove fluid and reduce swelling or inflammation to relieve pain.

Radiation therapy

Radiation therapy kills cancer cells by delivering high-powered beams of energy, such as X-rays or protons.

Radiation therapy can be provided in the following ways:

Radiation from an External Beam. This sort of radiation is produced by a machine that revolves around you as you lie on a table. The radiation is directed to certain locations on your body by the machine.
Radiation Treatment was given During Surgery (IORT). IORT is utilised after cancer has been removed following surgery. The radiation is focused on the area where the cancer was previously located. If the cancer is placed in a region where total removal of cancer during surgery is difficult, IORT may be advised.

Chemotherapy

Chemotherapy is a medicinal treatment that kills cancer cells by using chemicals. It can be taken as a pill, injected into a vein (intravenously), or both. Chemotherapy is most commonly used to treat undifferentiated pleomorphic sarcoma that returns or spreads to other parts of the body after the first treatment.

Targeted Drug Therapy

Targeted medication treatments are designed to target specific abnormalities found in cancer cells. Targeted medication treatments can kill cancer cells by inhibiting these aberrations. Targeted therapy medications may be coupled with chemotherapy in the treatment of undifferentiated pleomorphic sarcoma.

Surgical Treatment for Gastrointestinal Stomach Tumour

Surgery is usually the main treatment for gastrointestinal stromal tumours (GISTs) that haven’t spread. The goal of the surgery is to remove all of cancer.

The type of surgery needed depends on the location and size of the tumour.

Surgery for small GISTs

If the tumour is small, it often can be removed along with a small area of normal tissue around it. This is done through a cut (incision) in the skin. Unlike many other cancers, GISTs almost never spread to the lymph nodes, so removing nearby lymph nodes is usually not needed.

For some small cancers, “keyhole” (laparoscopic) surgery is an option. Instead of making a large incision in the skin to remove the tumour, several small ones are used. The surgeon inserts a thin, lighted tube with a tiny video camera on the end (a laparoscope) through one of them. This lets him or her see inside the belly. Long, thin surgical tools are then used through the other incisions to remove the tumour. Because the incisions are small, patients usually recover more quickly from this type of surgery than from traditional surgery that requires a longer incision.

Surgery for larger GISTs

If the tumour is large or growing into other organs, the surgeon might still be able to remove it entirely. To do this, parts of organs (such as a section of the intestines) might need to be removed. The surgeon might also remove tumours that have spread elsewhere in the abdomen, such as the liver.

Another option for tumours that are large or have grown into nearby areas might be to take the targeted drug imatinib (Gleevec) first, typically for at least several months. This is called neoadjuvant treatment and can often shrink the tumour, making it easier to remove with surgery.

Surgery for metastatic GISTs

Surgery is not a common treatment for a GIST that has spread (metastasized) to other parts of the body. Targeted therapy drugs are usually the first option for metastatic GISTs. But if there are no more than a few metastatic tumours and they respond well to targeted therapy, some doctors might advise surgery to remove them. No large studies have been done to show how helpful this is, but it might be an option. If your doctor offers this surgery, be sure you understand the goals and possible side effects.

If the tumours are in the liver and would be hard to remove, other options might include different types of local treatments, such as ablation or embolization.