Tag Archives: GIST

Advanced Endoscopic Procedures to Diagnose and Treat Gastrointestinal Stromal Tumors (GISTs)

Important advances over the last decade in our understanding of gastrointestinal stromal tumors (GISTs) have opened the door to earlier diagnosis, innovative treatment, and improved patient survival. Most often occurring in the stomach, GISTs are thought to arise from the interstitial cells of Cajal, and are marked by mutations in the c-kit proto-oncogene, which expresses CD117, linked to the potential for malignancy.

Raquel Davila, M.D., gastroenterologist from Penn State Hershey Gastroenterology and Hepatology notes, “Gastroenterologists and surgical oncologists at Penn State Hershey Medical Center routinely use endoscopic ultrasound (EUS), with or without fine needle aspiration (FNA) for GIST diagnosis and to rule out other diagnoses, such as lymphoma. EUS can delineate the gut wall layers, which is helpful to identify the location of the tumor; a GIST appears as a hypoechoic solid mass, most often in the fourth layer of the GI tract wall, the muscularis propria, and less commonly in the second or third layers [muscularis mucosae and submucosa, respectively].”

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Measuring the Impact of Advanced Endoscopic Techniques on Diagnosis and Treatment of Gastrointestinal Cancer

When a gastrointestinal tumor is detected, defining the risk of malignancy and the potential for metastasis, and deciding how to proceed with treatment are issues of immediate concern to both the physician and the patient.

“Often, tumors are found when patients have endoscopic evaluation for problems such as longstanding heartburn or iron deficiency anemia. The lesions may be asymptomatic, but progression can occur,” says Charles Dye, M.D., gastroenterologist from Penn State Hershey Gastroenterology and Hepatology. Dr. Dye explains, “Malignant tumors, such as gastrointestinal stromal tumors [GISTs], also look similar to nonmalignant growths, such as Schwannomas or leiomyomas.”

While tumor size and location can be indicators of a tumor’s malignant potential, pairing endoscopic ultrasound (EUS) with a biopsy technique may allow major surgery to be avoided. Benign tumors can be left in place, while malignant tumors can be staged and risk-stratified to allow the best and most minimally invasive treatment approach. While immediate cytological analysis yields important information about tumor type, ancillary analyses, such as immunohistochemistry and tumor cell mitotic rate, may take several days to complete.

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