Management of early asymptomatic gastrointestinal stromal tumors of the stomach

Abstract

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the digestive tract. Approximately two thirds of clinically manifest tumors occur in the stomach, nearly one third in the small bowel, and the rest in the colorectal region with a few cases in the esophagus. GIST originate within the smooth muscle layer in the wall of the tubular gastrointestinal tract and grow mostly toward the serosa, far less often toward the mucosa. In the latter case, ulceration may develop and can cause gastrointestinal bleeding as the cardinal symptom. However, most GIST of the stomach are asymptomatic. They are increasingly detected incidentally as small intramural or submucosal tumors during endoscopy and particularly during endoscopic ultrasound. Epidemiological and molecular genetic findings suggest that early asymptomatic GIST of the stomach (< 1 cm) show self-limiting tumorigenesis. Thus, early (< 1 cm) asymptomatic gastric GIST (synonym: micro-GIST) are found in 20%-30% of the elderly. The mostly elderly people with early gastric GIST have an excellent GIST-specific prognosis. Patients with early GIST of the stomach can therefore be managed by endoscopic surveillance.

Obscure Gastrointestinal Bleeding Due to a Small Intestinal Gastrointestinal Stromal Tumor in a Young Adult

“…The MIB-1 labeling index was <1%. These features were compatible with those of low-risk GIST [8, 9, 10]. …”

Population-Based Epidemiology and Mortality of Small Malignant Gastrointestinal Stromal Tumors in the USA

“…5,6 Given their small size, patients are often asymptomatic and tumors are typically discovered incidentally during endoscopic procedures by gastroenterologists or during cross-sectional radiologic studies. 7–10 It has been reported that up to 30 % of people have small GIST. 11–14 However, this data comes from autopsy studies and retrospective pathological series, making it limited by several biases.…”

Beyond standard therapy: drugs under investigation for the treatment of gastrointestinal stromal tumor

“…GISTs account for about 80% of gastrointestinal sarcomas, with a mean annual incidence of 10-15 per million [4, 5]. Nearly 50-70% of the clinically apparent tumors arise in the stomach, 20-30% arise in the small intestine, 5-15% in the large intestine, and less than 5% in other locations [6]. Activating mutations in the c- KIT (the normal cellular homologue of the Hardy Zuckerman 4 feline sarcoma viral oncogene homologue, NCBI gene ID: 3815) or the platelet-derived growth factor α ( PDGFRA ) proto-oncogenes exist in about 85% of GISTs and are important factors in the pathogenesis of these tumors [7, 8].…”