gastrointestinal%20stromal%20tumor
GASTROINTESTINAL STROMAL TUMOR
Gastrointestinal stromal tumors are morphologically spindle cell, epithelioid, or occasionally pleomorphic mesenchymal tumors of the gastrointestinal tract.
Signs and symptoms of gastrointestinal tumor include presence of abdominal mass (which may be an incidental finding in endoscopy), gastrointestinal bleeding, hemoperitoneum, anemia and gastrointestinal perforation.

Follow Up

  • Relapses affect the liver & peritoneum & rarely the bone
    • Risk of relapse is high w/ ruptured tumors
  • Evaluate tumor response by checking for tumor shrinkage, tumor density changes on computed tomography (CT) scan, & absence of tumor progression
  • For gastrointestinal stromal tumors (GISTs) <2 cm w/o high-risk endoscopic ultrasound (EUS) features, consider endoscopic surveillance every 6-12 months

Post-surgery

Completely Resected Tumors w/ or w/o Pre-operative Imatinib

  • Clinical evaluation every 3-6 months x 5 years, then annually
    • May be less frequent for small tumors (<2 cm)
  • Abdominal/Pelvic CT every 3-6 months x 3-5 years, then annually

Metastatic Disease or Persistent Gross Residual Disease w/ or w/o Pre-op Imatinib

  • Clinical evaluation & abdominal/pelvic CT every 3-6 months
    • May be less frequent for small tumors (<2 cm)

Management of Disease Progression

Limited Disease Progression

  • Continue or increase Imatinib dose as tolerated or may change to Sunitinib & reassess tumor response via positron emission tomography (PET) or CT
  • For progressing lesions while continuing Imatinib, consider surgical resection if still feasible, radiofrequency ablation or embolization, or palliative radiation therapy for bone metastases

Systemic Disease Progression

  • Increase Imatinib dose as tolerated or may change to Sunitinib & assess response via PET or CT
  • If still w/ limited or systemic disease progression, consider Regorafenib, a clinical trial or supportive care
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