Cancer registries
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GIST

Histopathologic image of gastrointestinal stromal tumour of the stomach. Hematoxylin-eosin stain.
Source: Wikipedia.

Gastrointestinal stromal tumour (GIST) is a very rare cancer affecting the digestive tract or nearby structures within the abdomen. GI stromal tumour, or GIST, is a sarcoma. Sarcomas are cancers that grow from cells of the body’s connective or supportive tissues such as bone, cartilage, tendons, nerves, fat, muscle, synovial tissue (tissue around joints), or blood vessels. GISTs arise either from cells called Interstitial Cells of Cajal (ICCs) or from less differentiated stem cells or precursor cells that can develop into ICCs. The ICCs are known as “pacemaker cells of the gut” because they send signals to trigger peristalsis, the digestive tract’s muscular contractions that move food along its course.

Primary gastrointestinal stromal tumours (GISTs) may occur anywhere along the gastrointestinal tract from the oesophagus to the anus. The most frequent site for GISTs is the stomach (about 55%), followed by the duodenum and small intestine (about 30%), oesophagus (about 5%), rectum (about 5%), colon (about 2%), and rare other locations.

The most common sites for metastasis are the liver and the abdominal membranes (peritoneum, mesentery, omentum). GIST rarely spreads to lymph nodes, but it may occasionally affect local abdominal lymph nodes. Unusual sites of metastasis include lung and bone tissue, as well as pelvic sites such as the ovaries (Belics et al, 2003; Irving et al, 2005; Wingen et al, 2005). Extremely rare sites of metastasis include breast (Igwilo et al, 2003) and muscle tissue of the arm.

Gastrointestinal stromal tumour (GIST) is quite rare. It is often stated that gastrointestinal stromal tumours are the most common mesenchymal tumours of the GI tract, but this only means that they are slightly less rare than the other tumours in this category. GISTs account for only 1-3% of gastric (stomach) tumours, about 20% of small bowel tumours, and 1% or less of colorectal tumours. The vast majority of tumours in these locations are carcinomas within the tissues lining the GI tract. Most primary care physicians and many pathologists and oncologists go through their entire professional careers without seeing a single GIST. This is important to patients because misdiagnosis can delay the start of appropriate treatment. The physicians at major cancer referral treatment centres, especially those with sarcoma teams, are much more likely to be familiar with gastrointestinal stromal tumour and its treatment.

References

  • Belics Z, Csapó Z, Szabó I, Pápay J, Szabó J, Papp Z. Large gastrointestinal stromal tumor presenting as an ovarian tumor. A case report. J Reprod Med 2003; 48(8):655-658.
  • Igwilo OC, Byrne MP, Nguyen KD, Atkinson J. Malignant gastric stromal tumor: unusual metastatic patterns. South Med J 2003; 96(5):512-515.
  • Irving JA, Lerwill MF, Young RH. Gastrointestinal stromal tumors metastatic to the ovary: a report of five cases. Am J Surg Pathol 2005; 29(7):920-926.
  • Wingen CB, Pauwels PA, Debiec-Rychter M, van Gemert WG, Vos MC. Uterine gastrointestinal stromal tumour (GIST). Gynecol Oncol 2005; 97(3):970-972.