Benign GIST Tumor Treatment

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What is a Benign GIST Tumor? A benign gastrointestinal stromal tumor, also known as a benign GIST tumor, is a condition wherein the tissues of the gastrointestinal system develop aberrant cells. Rare mesenchymal tumors called gastrointestinal stromal tumors (GIST) can develop anywhere along the gastrointestinal tract’s smooth muscle layer. On rare occasions, they can arise… Read More

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Benign GIST Tumor Treatment

What is a Benign GIST Tumor?

A benign gastrointestinal stromal tumor, also known as a benign GIST tumor, is a condition wherein the tissues of the gastrointestinal system develop aberrant cells. Rare mesenchymal tumors called gastrointestinal stromal tumors (GIST) can develop anywhere along the gastrointestinal tract’s smooth muscle layer. On rare occasions, they can arise within the greater omentum, esophagus, appendix, and gallbladder.

 

Benign GIST Tumor Treatment
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What are the Predisposing Factors?

The majority of GIST cases are sporadic and thus have no known cause. However, the predisposing factors include:

  • Genetic factors: Genetic conditions such as Neurofibromatosis type 1 (NF1) and Carney triad have been linked to increased risk of GIST.
  • Age: GIST is more common in individuals above 50 years of age.
  • Gender: Men are more likely to have GIST than women.

Symptoms of Benign GIST Tumor

  • Abdominal pain or discomfort.
  • Bloody stool or vomit.
  • Difficulty in swallowing.
  • Feeling full after eating only a small amount of food.
  • You can feel a bulk in the belly with your hand.
  • Bowel obstruction
  • Nausea and vomiting
  • Fatigue due to anemia.

Diagnosis of Gastrointestinal Stromal Tumors

Benign GIST tumor diagnosis
Picture courtesy:  Medscape

Diagnosis of GIST begins with a complete history and physical examination. Following this, the tests listed below may be conducted.

  • Complete blood count (CBC): A complete blood count gives a picture of what the red and white blood cells are like. This can serve as a diagnostic aid.
  • Blood chemistry test: This test shows your creatinine, bicarbonates, electrolytes, total protein, and bilirubin levels. This helps to assess the liver and kidney functions.
  • X-rays: X-rays are used to check the gastrointestinal tract and associated organs and tissues for signs of tumor and possible metastasis.
  • Computed tomography (CT) scan: This is another way to look for the presence of tumors in the organs.
  • Magnetic resonance imaging (MRI): This test uses radio waves and strong magnets to create detailed images of the organs. This is particularly helpful in determining the presence of cancer and possible metastasis.
  • Biopsy: To arrive at a definitive diagnosis, samples of the tumor would be collected with the aid of an endoscope and examined. Immunohistochemistry to check for specific antibodies can also aid in arriving at a definitive diagnosis.

What are the Benign GIST Tumor Treatment Options?

Since the tumor is of benign origin, most medical practitioners may advise patients against any form of treatment especially if the tumor does not affect the quality of life. However, treatment is based on several factors. These include:

  • Resectable: These tumors can be removed by surgery. This is dependent on the size and location of the tumor.
  • Unresectable: Surgical removal of these tumors leaves some of them behind. This means that additional treatment is needed.
  • Metastatic and recurrent: Although benign GIST tumors are not metastatic, the majority of cases become metastatic with time.
  • Refractory: Despite treatment, these tumors have not improved.

There are different types of treatment for patients with benign gastrointestinal stromal tumors. The four types of standard treatment are used:

Surgery: 

Surgery is usually the main treatment for benign gastrointestinal stromal tumors (GISTs). The surgery aims to remove all of the tumor. The location and size of the tumor determine the kind of surgery that is required.

  • Surgery for small GISTs: For small tumors, they can be removed along with a small area of normal tissue around them. An incision in the skin is made to do this. For some small benign GIST, laparoscopic surgery is used. Several small incisions are made, and the laparoscope is passed through it. The size of the incision makes recovery quicker and complications less.
  • Surgery for larger GISTs: If the tumor is large, a longer incision is used during the removal. This has more chances of leading to post-operative complications such as hemorrhages, infection, adhesion of tissues, nerve damage, etc.

Chemotherapy for Gastrointestinal Stromal Tumors: 

Chemotherapy is the use of drugs to treat cancer. This includes both traditional chemotherapy drugs and targeted therapy drugs. However, traditional chemotherapy drugs are ineffective in the reduction of benign GIST cells and are rarely used in recent times. Their side effects such as nausea and vomiting, loss of appetite, mouth sores, diarrhea, hair loss, fatigue, immunocompromising effects, and bleeding issues, also make them unfavorable. Drugs are used in targeted therapy to locate and kill particular cancer cells. It usually causes less harm to normal cells than chemotherapy or radiation therapy do.

Tyrosine kinase inhibitors (TKIs), which are medications used in targeted therapy, block the signals required for cancer to spread. These drugs are effective when tumors cannot be surgically removed. Examples of such drugs include:

  • Imatinib: Most patients with GISTs eventually receive treatment with this medication. Tumors can be tested for certain mutations in certain genes before treatment, which can help in determining the effectiveness of the drug. It can be used to shrink tumor cells and as an adjunct therapy post-operatively. Side effects include edema, diarrhea, and hemorrhage if the tumor shrinks quickly.
  • Sunitinib: this drug is used when imatinib is not indicated. It has a broader spectrum of activity since it inhibits proteins that imatinib does not cover. It helps to prolong the life expectancy of the patient. Its side effects include fatigue, nausea, diarrhea, mouth irritation, liver damage, and high blood pressure.
  • Regorafenib: If imatinib and sunitinib are ineffective for treating advanced GISTs, regorafenib may be administered. Regorafenib can slow tumor growth and lead to tumor shrinkage in some cases. Common side effects include belly pain, diarrhea, fatigue, mouth or throat irritation, fever, inappetence, and weight loss. Rare side effects include bleeding disorders, high blood pressure, skin rashes, etc.
  • Other drugs used when the above are no longer functional include Ripretinib and Avapritinib.

Watchful waiting: 

This involves close monitoring of the patient to ensure that the tumor is not progressing or becoming malignant. This is done together with lifestyle modification. Treatment is only instituted if the risk of malignancy or quality of life would be affected by the tumor.

Supportive care: 

Different approaches are used as supportive care in benign GIST treatment. This is dependent on the situation. Emotional, physical, and radiotherapy serve as supportive treatments. Radiation therapy can be used to manage tumors although the benefits of the procedure are to be considered as severe side effects exist. Other forms of supportive therapy include Complementary and Integrative Medicine. This involves the addition of beneficial activities to aid in palliative care.

Conclusion

It is essential to discuss the diagnosis and possible treatment options with the physician as most tumor treatments come with side effects. This means that every treatment plan is tailored to suit the individual depending on factors such as age, health status, etc.