Gastrointestinal stromal tumor natural history

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]

Gastrointestinal stromal tumor Microchapters
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Overview

Most common site of involvement of GIST is stomach(70%).

Natural history

• Around 75% patients of gastrointestinal stromal tumors (GIST) are asymptomatic and are diagnosed as an incidental finding on imaging studies done for other reasons.
• If left untreated, patients with GIST may progress to develop abdominal pain, abdominal distension and perforation.
• Depending upon the type of GIST (benign or malignant), a benign GIST may remain unchanged for years before its progression into malignancy.
• GIST are highly vascular and an untreated tumor may attain massive size leading to intra-abdominal or gastrointestinal bleeding.
• A ruptured GIST may lead to coffee ground emesis, black stools or even malena.
• Ultimately, the GIST may metastasize and turn fatal.

Complications

• Gastrointestinal bleeding
• Bowel obstruction
• Bowel perforation
• Peritonitis
• Volvulus
• Intussusception
• Surgical complications associated with resection include:
  • Atelectasis
  • Pneumonia
  • Urinary tract infection
  • Abscess formation
  • Small-bowel obstruction
  • Deep venous thrombosis

Prognosis

• Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary.
• Prognosis of GIST depends upon size, location, spread and mitotic rate of the tumor (mitoses per 50 high-power fields).
  • Patients with gastric GIST have been reported to have better outlook as compared to patients with extragastric GIST.
  • Patients with localized primary disease have a average survival period of 5 years.
  • Patients with malignant lesions and metastasis have an average survival period of 1-2 years.
  • Patients with mitotic rate of >10 per 50 HPF have an average survival period of 1.5-2 years
  • Patients with mitotic rate <10 per HPF have an average survival period of 8 years.

Refrences

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