Surprising predictions part 4

 Gastrointestinal stromal tumor: Don't let it take you by surprise

Gastrointestinal stromal tumors (GISTs) are rare tumors of the digestive tract, with only about 2,600 new cases diagnosed each year in the United States. The majority of these benign growths are found in the small intestine, but they can also occur in the stomach or large intestine as well. GISTs affect both men and women, with males slightly more likely to be affected than females; however, the exact cause of GISTs is still unknown and it is not currently considered to be inherited.

What is gastrointestinal stromal tumor?

Gastrointestinal stromal tumor is a type of cancer that forms in the gastrointestinal tract. The gastrointestinal tract includes the stomach, small intestine, large intestine, rectum, and anus. This type of cancer is also called GIST. Gastrointestinal stromal tumors are rare. They are more common in men than women and usually occur after age 50.

What are the symptoms of gastrointestinal stromal tumor? (three sentences): The most common symptom of gastrointestinal stromal tumor is abdominal pain. Other symptoms may include bloating, nausea, vomiting, weight loss, fatigue, and blood in the stool.

What causes gastrointestinal stromal tumor? (two sentences): The cause of gastrointestinal stromal tumor is unknown. People with certain gene mutations have an increased risk for developing this disease. These genes include KIT, PDGFRA, CDKN2A/p16INK4a, CCND1/cyclin D1, CDK4/p16INK4B, CDK6/p25INK4C and RET. There are other factors that may contribute to gastrointestinal stromal tumor, such as radiation exposure, low vitamin A levels or infection with Helicobacter pylori bacteria. 

Symptoms of gastrointestinal stromal tumor can be hard to identify early on because they can be mistaken for another condition or illness. You should see your doctor if you experience any new symptoms such as fever, rapid heart rate, unexplained weight loss or pain near your abdomen. Your doctor will conduct a physical exam and review your medical history before giving you a diagnosis. 

The treatment options depend on the stage of the cancer and how advanced it is. Surgery is often recommended if the tumor can be removed without damaging nearby organs. Chemotherapy drugs can shrink cancer cells and help them become more sensitive to radiation therapy treatments. Radiation therapy delivers high-energy beams of light that destroy tissue within a specific area of the body. Targeted therapy using monoclonal antibodies against cancer cells is used less often but has shown promising results in treating some cancers including gastrointestinal stromal tumors. Patients who need to have surgery for their cancer often need to recover from the procedure. They will likely spend time in the hospital and receive IV fluids, antibiotics, pain medicine and nutritional supplements during their recovery.

Long term effects of gastrointestinal stromal tumor vary depending on where the tumor originated in the GI tract and what part of it was affected. Side effects from chemotherapy may include hair loss, mouth sores, difficulty swallowing, infections and nerve damage. Side effects from radiation therapy may include fatigue, skin irritation and pain in the treated area. It's important to know the side effects so you can plan ahead for them. Talk to your doctor about which treatment might work best for you based on your overall health status. Discuss the pros and cons of each option and get as much information as possible. Be sure to ask any questions you have and don't hesitate to seek a second opinion. If you decide to proceed with a treatment, make sure you have the support of your family and friends. Treatment is not a cure for gastrointestinal stromal tumor. It can reduce the size of the tumor and slow down its growth. Some people can live for years without any symptoms, while others may die as soon as six months after being diagnosed. For many, the prognosis is good. The gastrointestinal stromal tumor may be found and removed before it spreads to other parts of the body. Others may be able to have a partial or total removal of the tumor with a long period of remission. Even though there is no cure for gastrointestinal stromal tumor, it can be managed successfully with proper treatment. Many people with gastrointestinal stromal tumor can have a partial or total removal of the tumor with a long period of remission. The symptoms and treatment depend on the type and location of the tumor. With awareness, patience, and appropriate care, your gastrointestinal stromal tumor can be manageable. Doctors may recommend surgery, radiation therapy, and/or chemotherapy to manage your cancer. 

Your symptoms and treatment will depend on the type and location of the tumor. Doctors may recommend surgery, radiation therapy, and/or chemotherapy to manage your cancer. For those that choose to go through with treatment, it is important to have the support of family and friends. Together you can make informed decisions on the most suitable course of action for you given your current health status. Gastrointestinal stromal tumor, like all cancers, does not discriminate. But it can be handled successfully with the right treatment. When you're facing the prospect of surgery, radiation, and chemotherapy, a little advice goes a long way. Find out everything you can about your tumor and the various treatment options available to you. Seek a second opinion when necessary. Talk to your doctor about which treatment might be best for you. Plan ahead for any side effects by making sure your family and friends are aware of them too. A diagnosis of gastrointestinal stromal tumor can be scary, but it doesn't mean that life is over. Your physical symptoms and treatment will depend on the type and location of the tumor. However, a few things remain constant-the need for understanding, support, and knowledge. That's why we've created this blog post to offer some insight into living with this disease-to help answer some common questions patients have about their condition. Remember that you're not alone; gastrointestinal stromal tumor affects one out of every 100 people in the United States every year. It is estimated that more than 20,000 new cases of gastric stromal tumors will be diagnosed in 2017. That number is expected to increase by 10% annually until 2022, when an estimated 27,000 new cases will occur annually. Fortunately, the odds of surviving more than five years after a diagnosis increase significantly if the tumor has been caught early and removed surgically without spreading elsewhere in the body. As always consult your physician before taking any actions.

Awareness and education can save lives! So please share this blog post and talk to your friends and family members about GIST. The more awareness there is, the better chance of survival we'll have against GIST. Please read our blog post, Gastrointestinal Stromal Tumor: Symptoms, Causes, and Treatment to learn more about how you can prevent or detect stomach stromal tumors. 

Summary GIST (gastrointestinal stromal tumor) is a cancer that forms in certain cells in tissue that lines organs in your digestive system, such as your stomach, small intestine, and colon. Researchers believe that some people inherit a gene mutation from one parent that causes them to develop GISTs early in life. However, most individuals diagnosed with GIST are not genetically predisposed to it and do not have a strong family history of cancer. In these cases, doctors aren't exactly sure what causes GIST. Some possible risk factors include obesity, smoking, alcohol consumption, diet high in salt and low in fresh vegetables and fruit. 

Symptoms of GIST include abdominal pain that increases during meal times or at night; nausea or vomiting; diarrhea or constipation; difficulty swallowing food and difficulty breathing while eating. Other signs of GIST can be weight loss, unintentional weight gain, fever, and fatigue. If you experience any of these symptoms, or think you may have a GIST or other intestinal tumor, contact your healthcare provider immediately. Treatments for GIST vary depending on the tumor's size and location. Surgery is often the first step in treating a GIST tumor. Chemotherapy and radiation are used to treat a GIST that cannot be removed by surgery.

Who are at risk?

People of all ages can develop gastrointestinal stromal tumors (GISTs), but the vast majority are diagnosed in adults over the age of 50. There are slightly more men than women with GISTs. The cause of most GISTs is unknown, but there are some risk factors that have been identified. These include- Being white and having a family history of the disease 

- Having an inherited disorder called familial adenomatous polyposis (FAP) 

- A previous benign or malignant tumor on the same organ 

- Having a syndrome called von Hippel-Lindau disease 

- A prior history of cancer including Hodgkin's lymphoma, leukemia, breast cancer, colon cancer, pancreatic cancer and other types of cancers. Gastrointestinal stromal tumors grow rapidly and aggressively, so if they aren't removed they can become life threatening within months. If you have any symptoms or think you may be at risk for developing this type of tumor, see your doctor right away to find out what steps need to be taken next. There are many treatments available to help patients manage GISTs depending on how much they interfere with daily activities and which part of the body is affected. When a patient has had one localized recurrence after surgery, radiation therapy can usually control the tumor well enough for extended periods without causing too many side effects. Chemotherapy treatments might also be necessary when chemotherapy drugs such as imatinib fail to stop or prevent the tumor from growing again. For recurrent tumors elsewhere in the body, chemotherapy and targeted therapies like imatinib might be necessary too. Surgery remains the most effective treatment option for local GISTs, although it doesn't work as well when the tumor has spread. Surgery often isn't appropriate because these tumors often return. Doctors recommend removing these types of tumors even if they don't appear to be obstructing anything because often times patients will experience additional complications down the line due to their growth rate and aggressiveness. Some patients may be able to get by with no treatment if the tumor is small and located near the stomach. But this approach requires careful monitoring since gastric stromal tumors grow quickly and can eventually invade nearby organs. In most cases, the best treatment plan involves removing the tumor along with adjacent tissue and lymph nodes that contain cancer cells during surgery. This is followed by chemotherapy with medication such as imatinib mesylate, dasatinib, sunitinib or sorafenib which inhibit signals that promote tumor growth. Radiation therapy can also be used to shrink and destroy the remaining tumor cells. New research suggests that certain types of medicines like azacitidine and decitabine may increase the effectiveness of chemotherapy in treating GISTs. However, doctors are still working to determine the safety and effectiveness of these medications. Targeted cancer therapies can also be used to fight GISTs in certain situations. Patients with advanced GISTs who have not responded to chemotherapy or radiation can be treated with monoclonal antibodies that are designed to target cancer cells. Recently, researchers found that the drug regorafenib was successful in helping patients live longer with metastatic GISTs. This is good news for people living with this aggressive form of cancer who haven't found success with traditional treatments. Despite its complex nature, research is continually expanding our understanding of GISTs and new approaches to treating them are constantly being investigated.

What are the common symptoms?

Gastrointestinal stromal tumors (GISTs) are abnormal growths that can develop in the gastrointestinal tract. They are most commonly found in the stomach or small intestine, but can also occur in the esophagus, large intestine, or rectum. GISTs are usually asymptomatic, meaning they do not cause symptoms. However, some people with GIST may experience abdominal pain, bloating, nausea, vomiting, or weight loss. If the tumor is large enough to compress surrounding structures, it may cause obstruction of the bowel or bleeding. For this reason, many GISTs are detected incidentally during screening for other conditions such as colon cancer or gastric ulcers. Most often, a person will go to their doctor because of symptoms and an endoscopy will be performed where doctors insert a long tube with a camera on one end down into the throat and up into the stomach and intestines. A biopsy will then be taken to confirm whether there is cancerous tissue present. Fortunately, the prognosis for patients with GIST is excellent. Treatment options include surgery, chemotherapy and/or radiation therapy depending on the size of the tumor and its location. Patients who undergo surgery typically have lymph nodes removed to determine if the cancer has spread. Radiation and chemotherapy treatments vary depending on factors such as how advanced the tumor is and how well the patient responds to treatment. Some people may need only one treatment option while others require more than one type of treatment. 

A very important fact about GISTs is that they can sometimes recur after treatment so monitoring over time is necessary. The good news is that those who undergo complete surgical removal of the tumor have a low risk of recurrence. The National Cancer Institute estimates that 3 out of 4 people diagnosed with GIST live at least 5 years following diagnosis. Due to advances in medical technology, diagnosis and treatment for GIST have improved dramatically over the last 10-15 years. Newer diagnostic tests like CT scans and magnetic resonance imaging allow physicians to better visualize the tumor's location and size. More accurate scans make surgical procedures less dangerous and less invasive which means quicker recovery times, fewer complications, and lower risks of infection. With these new imaging techniques available, doctors have been able to find smaller GISTs earlier which means more cases are being treated successfully before the cancer spreads or becomes too large to remove surgically. Radiotherapy has also evolved significantly since it was first used in 1945. There are now different types of radiotherapy available including stereotactic radiosurgery which uses MRI imaging for localization purposes followed by precisely targeted high dose single fraction radiotherapy. Stereotactic radiosurgery allows for a highly focused radiation treatment and is typically an outpatient procedure with no serious side effects. Stereotactic body radiation therapy is another form of radiotherapy that can deliver the appropriate dose of radiation to the tumor from all angles, even when it cannot be seen on a scan. One downside to both forms of radiotherapy is that it may cause scarring in the area near the tumor which can lead to narrowing or obstructing of the intestinal tract. Chemotherapy is another effective treatment for GISTs, although it may not always work as well as other methods. Chemotherapy is more likely to be successful in people who have stage 1 or 2 GISTs. Side effects of chemotherapy can be significant and may include hair loss, fatigue, infections, and diarrhea. 

Another treatment option for GISTs is monoclonal antibody therapy which is an experimental treatment that has not yet been approved by the FDA. It works by attaching a monoclonal antibody molecule to the tumor cell membrane which creates a leaky tumor cell membrane and leads to rapid death of the cancer cells. There are currently four ongoing clinical trials using this method for GISTs with promising results so far. Two of the trials are examining how certain immunotherapies can help destroy GIST cells without harming healthy tissue. The other two studies are investigating ways to control blood vessel growth inside tumors in order to starve them. At the University of Texas MD Anderson Cancer Center, researchers are trying various combinations of drugs including Imatinib mesylate (trade name Glivec), Oxaliplatin (trade name Eloxatin), and Nab-paclitaxel (trade name Abraxane) as well as immunotherapy treatments such as vaccine delivery via nanoparticles coated with polyamidoamine dendrimers. Studies have shown that combining three or more treatments can reduce tumor progression while preserving quality of life during treatment but it remains unclear if this will result in longer survival rates among patients.

What causes gastrointestinal stromal tumors?

The cause of gastrointestinal stromal tumors (GISTs) is not currently known. However, researchers have identified a genetic mutation that is associated with the development of these tumors. It is believed that this mutation may cause the cells in the gastrointestinal tract to grow out of control. In most cases, the mutated gene is inherited from a parent. In some cases, the gene mutation occurs spontaneously. Symptoms of gastrointestinal stromal tumors (six sentences): The most common symptom of a gastrointestinal stromal tumor is abdominal pain. Other symptoms may include: weight loss, fatigue, bloating, blood in the stool, and nausea. If the tumor grows large enough, it can cause obstruction of the intestines. This can lead to vomiting and constipation. Sometimes a mass can be felt on physical examination or during an x-ray. Treatment for gastrointestinal stromal tumors (four sentences): Treatment for GISTs usually involves surgery to remove the tumor and nearby tissue. There are several types of surgery available, depending on where the tumor is located within the body. After surgery, many people will need additional treatment such as chemotherapy or radiation therapy because they will have an increased risk of developing cancer in other parts of their body due to their genetic predisposition towards GISTs. These treatments help lower the chance of recurrence. But if a person does develop cancer in another part of their body, it may be more difficult to treat. They should speak with their doctor about surveillance plans that are appropriate for them. A number of things can increase the risk of gastrointestinal stromal tumors including age, family history, genetics, having had stomach ulcers or colorectal polyps, previous exposure to certain medications like nitrosamines and alkylating agents; chronic gastritis; stomach inflammation; chronic intestinal inflammation like Crohn's disease or ulcerative colitis; intestinal parasites like schistosomes; excessive alcohol consumption; certain infections like Epstein Barr virus and herpes virus 8. When someone experiences any new symptoms after treatment, they should report it to their doctor immediately. Early detection and diagnosis can make a big difference in outcome. Learn more about what causes gastrointestinal stromal tumors, what symptoms to look for, and how they're treated at the American Cancer Society. The American Cancer Society recommends gastroenterologists for anyone who has been diagnosed with a gastrointestinal stromal tumor. For patients who are experiencing severe abdominal pain, bleeding from the rectum, unexplained weight loss, changes in bowel habits, vomiting, or blockage of food moving through the digestive system there is urgent need to consult a physician immediately so proper diagnosis and treatment can occur. Though research into the cause, prevention, and cure for gastrointestinal stromal tumors is ongoing, early detection of this potentially life-threatening condition can reduce risks. There is a variety of treatment options, but the course of action is dependent on the size and location of the tumor. Surgery, chemotherapy, and radiation therapy can all contribute to reducing the likelihood of relapse. 

One study found that almost all patients with gastrointestinal stromal tumors are genetically predisposed to developing them. This means individuals can reduce their chances of getting a tumor by avoiding environmental and lifestyle factors linked to higher rates of occurrence. Speak to your doctor today about the symptoms of gastrointestinal stromal tumors and ask if a screening test is appropriate. The sooner it is detected, the better the chances of a successful treatment. Even though the cause of gastrointestinal stromal tumors is unknown, it is important to remember that there are a number of ways to reduce the risk. By speaking with their doctor about what they can do to keep themselves healthy, a patient can take steps in preventing future illness. Patients are encouraged to maintain a healthy weight and exercise routine and limit their alcohol intake. Quitting smoking also reduces the risk of gastrointestinal stromal tumors. The National Cancer Institute reports that people who smoke tobacco have a much higher chance of developing this type of cancer than those who don’t smoke. There are more than 50 types of stomach cancer and because the symptoms vary from person to person, diagnosis may be delayed for some time. Once diagnosed, gastric cancer treatments depend on many different factors including the size and location of the tumor as well as how advanced it is when first diagnosed. Some forms are curable while others may not be; only an experienced physician will know for sure which course will work best for each individual case.

Treatments available for gastrointestinal stromal tumors

There are a few different treatment options available for gastrointestinal stromal tumors. Surgery is the most common and can be used to remove the tumor and a small margin of healthy tissue around it. If the tumor can't be removed completely, surgery may be combined with other treatments like radiation or chemotherapy. Targeted therapy drugs can also be used to treat gastrointestinal stromal tumors. These drugs work by targeting specific mutations that are found in some of these tumors. Clinical trials are also an option for some people with gastrointestinal stromal tumors. A clinical trial is when a new drug or treatment is tested on humans to find out if it's safe and effective. Gastrointestinal stromal tumors can sometimes go away on their own without any medical intervention, but doctors recommend treating them right away because they often come back later. To determine what type of treatment would be best for you, your doctor will need to run tests to see where the tumor is located, how large it is, and what kind of cells make up the tumor. Treatment usually begins with surgical removal of the tumor, which is called debulking. Debulking removes as much cancerous tissue as possible, but this doesn't always eliminate all signs of cancer. In order to help reduce chances of recurrence, surgeons may need to remove nearby lymph nodes during surgery. As part of treatment, you might have regular follow-up visits after surgery so your doctor can monitor for signs that the cancer has returned or spread elsewhere in the body.The next step for many patients with gastrointestinal stromal tumors is surgery. When this isn't enough, other treatments such as radiation and chemotherapy may be recommended. It's important to know that there are different types of cancers that affect the GI tract, not just gastrointestinal stromal tumors (see our blog post Types of GI Cancers here). Your doctor will need to do tests to see what kind of tumor you have and then talk about potential courses of action. The course of treatment will depend on the type and size of your tumor. The location of the tumor and whether it contains cells from one or more organs will also play a role in deciding the best course of treatment. For example, surgery to remove a pancreatic neuroendocrine tumor is typically very complex and includes removing surrounding organs, while gastric adenocarcinoma (a type of stomach cancer) may only require partial removal. After diagnosis, many patients undergo some form of surgery to fully or partially remove the tumor. 

In cases where this isn't enough, radiation therapy and chemotherapy are also used as treatment options. Chemotherapy is a medication that kills cancer cells and slows down tumor growth. It works by damaging the DNA inside the cancer cell, causing it to die over time. Radiation therapy uses high-energy x-rays to kill both fast-growing normal cells and slow-growing abnormal ones. During treatment, both types of cells are at risk for damage from radiation. Generally speaking, patients undergoing either chemotherapy or radiation experience side effects ranging from fatigue to hair loss; these side effects vary depending on the person's age and health status before treatment began. Both chemo and radiation can result in infertility due to long term changes in hormone levels; though fertility rates tend to return following treatment completion

Prevention of gastrointestinal stromal tumors

Although there is no guaranteed way to prevent gastrointestinal stromal tumors, there are some things you can do to lower your risk. For example, quit smoking, eat a healthy diet, and get regular exercise. If you have a family history of the disease, talk to your doctor about genetic counseling and testing. And if you experience any symptoms, don't delay in getting them checked out by a medical professional. The most common GI-tumor symptom is bleeding from your rectum. Bleeding anywhere else (e.g., bloody stool or vomit) should also be investigated immediately because it could indicate something else entirely—though this may be more likely with hemorrhoids or an ulcer that has been ignored for too long and now ruptured. Other GI-tumor symptoms include weight loss; nausea; appetite loss; fever; pain, gas, bloating, constipation or diarrhea; fatigue; cough or other respiratory problems such as difficulty breathing/swallowing/breathing normally/speaking without wheezing/coughing up blood. The signs and symptoms of gastrointestinal stromal tumors depend on where they form in the body. In the stomach, they cause chest pain or heartburn. In the esophagus, they produce severe dysphagia (difficulty swallowing). Signs and symptoms vary depending on which organ is affected. If a mass grows near one of these organs but not inside it, they can press against nerves causing pain that spreads to other parts of your body like your back or hips. GI-tumors can also grow along the large intestine, bladder, uterus, prostate gland, small intestine, and pancreas. Depending on their location within those organs, they can cause symptoms including bowel obstruction and urinary retention. The most common cancerous tumor in the intestinal tract is called adenocarcinoma or carcinoid. These cancers tend to spread fast so it's important to know how to spot the warning signs of a potential growth before it becomes deadly. Red flags include unexplained weight loss, persistent fever or night sweats, unexplained changes in bowel habits, change in mental state, persistent abdominal discomfort or pain that does not go away after eating. Some people with gastric or colonic cancer might develop unusual cravings. They might also notice lumps in their skin around the anus, groin, breasts, underarms, neck or eyelids. A poor prognosis often accompanies this type of GI-tumor due to its rapid progression to metastasis. Noncancerous masses that arise in the gallbladder can produce fever and chills and sometimes jaundice (yellowish skin color), though not all types cause those particular symptoms. GI-tumors can also be benign, meaning they won't turn into a malignant tumor. Sometimes the best treatment is simply to remove the mass and see what happens, because it can be very difficult to diagnose the difference between a malignant and benign tumor without surgery. The first step in treating GI-tumor symptoms is to consult with your doctor or general practitioner who will then decide whether you need further tests. Diagnostic imaging tests such as x-rays, CT scans, MRIs, or ultrasounds are done to look for any abnormal tissue growths that may warrant further investigation. The most common diagnostic test is a colonoscopy. If the patient experiences rectal bleeding, he or she may be asked to undergo a sigmoidoscopy or double-contrast barium enema. Endoscopic retrograde cholangiopancreatography (ERCP) is another useful diagnostic test that helps determine the cause of bile duct and pancreatic duct obstructions. This procedure involves inserting a tube with a camera on the end down your throat and through your digestive system to take pictures of any abnormalities in your digestive tract. It is usually a minimally invasive test, and your bowel movements should return to normal the day after. Most doctors recommend it if you experience unexplained weight loss, persistent fever or night sweats, unexplained changes in bowel habits, change in mental state, persistent abdominal discomfort or pain that does not go away after eating. 

You should also have a stool sample taken for testing as well as any other routine tests your doctor recommends to make sure everything else is functioning properly. The treatments for GI-tumors depends on the type of tumor you have and where it is located. Treatment options include surgery (either removing the tumor or just taking biopsies), chemotherapy and radiation therapy.