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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.

Surgical Intervention

  • Complete surgical excision is the standard treatment of localized gastrointestinal stromal tumor (GIST)
    • Initial management of small GISTs <2 cm w/ high-risk endoscopic ultrasound (EUS) features
  • Wide local resection w/ 1- to 2-cm margin is done for most tumors
  • Tumors located in the colon may require hemicolectomy while tumors located in the rectum & anus will require abdominoperineal resection of the anus & rectum
  • Surgery may be warranted in unresectable or metastatic GIST if there is limited disease progression unresponsive to Imatinib or a locally advanced previously unresectable tumor which had a good response to Imatinib preoperatively

Preoperative Assessment

  • Computed tomography (CT) scan of the chest & abdomen should be done on all patients
    • Angiography performed if necessary (eg major vessels occluded by the tumor)
  • If large tumors are considered on the right or left upper quadrant of the abdomen, endocrine clearance should be done to exclude adrenal tumors
  • Alpha-fetoprotein (AFP) & beta-human chorionic gonadotropin (Β-hCG) levels should be determined in male patients w/ centrally placed tumors to exclude teratomas
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Erica Makin, MBChB, MSc, FRCS (Paeds); Mark Davenport, ChM, FRCS (Eng), FRCS (Paeds), 01 Apr 2013

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