Introduction about GIST in special gastric GIST
Gastrointestinal Stromal Tumor (GIST) is a soft tissue sarcoma, which grows as a loose tissue or across the gastrointestinal (GI) track. The tumor is not common with an account of below 1 percent of GI tumors although it is the most common of mesenchymal neoplasmas that affects the GI tract (Menge 335; Corless 19). The sarcoma can occur anywhere along the GI, but it is common in the stomach and small intestine. The tumor varies in characteristics depending on the location, size and cell division. The size can vary between 4 mm and 35 cm (Menge 335). The characteristics determine whether the GIST expands to other areas of the body. GIST occurs in the interstitial cells of Cajal (ICC) also called the “pacemakers” (Ma 300; Al-Shboul 3) The cells belong to the nervous system known as an autonomic nervous system, which is responsible for regulating processes of the body like food digestion. ICCs signal the GI to contract and relax the muscles to allow food and other liquids flow (Klein 1635).
Although there is no much about the risk factors of GIST, it affects most old people between 40 and 80 years (Kramer 57). Also, there is a rare un inherited risk factor, a gene mutation with chances of developing GIST. Another risk factor is the primary familial GIST syndrome, a condition that is inherited (Menge 338). The syndrome can lead to the development of GIST at an early age than the expected 40 and in more than one form. Primary familial GIST syndrome originates from KIT, an abnormal gene that a child gets from parents (Zhu 4289). The abnormal gene is found in all cells of those people who inherit it but in cancer cells for those with sporadic GIST. The syndrome can also result from a change in the PDGFRA gene (Boikos 925; Astolfi 892). Another risk factor to GIST is the Neurofibromatosis type 1 disease which results from the defection of the NF1 gene, and it can be inherited (Menge 337; Al-Shboul 3). Carney-Stratakis syndrome, an inherited condition also risks the development of GIST at early ages.
Symptoms of Special Gastric GIST
Some of the symptoms, which may suggest that a person has GIST, include upper abdominal pain, abdominal fullness, nausea, heartburn or an early feeling of being full than expected (Menge 338; Zebary 560) Also, a patient may have blood on the stool or experience acute hematemesis.
Doctor’s Exclusion of more Common Cause and Think in GIST from the Symptoms
Abdominal pain, feeling of early fullness and abdominal fullness may result from the insensitivity of the ICCs. The cells may become unable to regulate the gastric activities leading to hardening of the walls, which makes one feel pain or even full. Also, one may feel full early than usual because the GI is not allowing food to flow in the stomach due to the failure of muscle contraction (Iorio 1377; Hirahara 710; Huynh 9). GIST is one cause of inactiveness in ICCs, which may make the IG muscle cells unable to respond.
GIST prevents mutation in KIT genes (Menge 339). The inhibition increases the symptoms of dyspepsia (Yu 11800). That is the reason why doctors may think of GIST on seeing amplified symptoms of dyspepsia. The function of the KIT gene is to help in the development and role of some cells once it receives signals (Zhu 4285; Xiao 4; Ye 12; Kasetsermwiriya 126). One of the cells which KIT help to function and develop is the ICCs found on the GI. When tumors inhibit the KIT proteins, they do not develop or coordinate the function of the ICC, and therefore the abdomen activities are halted leading to the symptoms described above. Since GIST is one of the factors, which inhibit the KIT gene, then the doctor may think of the tumor on seeing such signs (Zhu 4285).
The symptoms of nausea, heartburn, abdominal pain may occur because of the inhibition of the peritoneum structure, which produces fluid in the abdomen to allow food to move smoothly (Menge 335; Lee 13; Adams 3). The inhibition occurs when another layer forms on top of the peritoneum blocking the fluid from reaching the stomach. When the layer cannot produce the fluid or the fluid does not reach the abdomen, a person feels pain because of the increased friction in the stomach as well as heartburn and nausea. GIST is one cause of the inhibition of peritoneum from producing the gastric fluid by forming a layer on top (Scherübl 226; Rammohan 102). The condition occurs when GIST from the GI metastasize in an abnormal way to the abdominal wall (Huang 111; Kasetsermwiriya 128). A doctor, therefore, may think of GIST when there is a combination of abdominal pain, nausea, and heartburn.
Blood on the stool and hematemesis are an indication of a bleeding, abdominal wall or intestines. Because of the transmural growth, sometimes GIST grows to enormous sizes (Menge 335). Also, they have many blood vessels around them (Menge 335; Huang 110). The size may make the blood vessels to stretch so much until they leak blood. Even, as a person takes in food, the tumor gets scratched making blood to come out. The blood gets out through the mouth when it is too much or goes through the intestines and released through the stool. Symptoms of blood on the stool and hematemesis, therefore, may make the doctor think of GIST.
This study aimed to find out when patients can make an insight into gastric GIST from some symptoms. It employed primary sources including peer-reviewed journals to understand what GIST is, its causes as well as the symptoms. The research found that GIST is a tumor which attacks the soft tissue and grows across the GI tract. A person can have an un-inherited risk factor inform of a gene mutation or inherited leading to the sarcoma. Although it can occur at any part along the GI, it affects the small intestines and the stomach more. The Symptoms include an early feeling of fullness, abdominal fullness, and pain, blood on the stool and hematemesis. With those symptoms, patients can think of gastric, but they require further analysis from a clinician to strengthen the insights.
Abdominal pain, feeling of early fullness and abdominal fullness may result from the insensitivity of the ICCs. The cells may become unable to regulate the gastric activities leading to hardening of the walls, which makes one feel pain or even full. GIST is one of the conditions which can inhibit the functioning of ICCs and therefore, the gastroenterologist can conclude of the tumor on seeing such symptoms. Clinicians should apply the knowledge from this study to help more patients who may not be aware that they have cancer. The gist is not common, and therefore it is hard for people to think of it when they have stomach problems. The symptoms are common to other stomach problems, and consequently, it might be hard for one to guess of GIST. A gastroenterologist should seek more information from patients with stomach problems to help identify whether they might be having GIST.
Adams, Haley S., et al. “Inflammatory Fibroid Polyp: An Unusual Cause of Ileoileal Intussusception.” Case Reports in Surgery, Nov. 2017, pp. 1–4.
Al-Shboul, Othman A. “The importance of interstitial cells of Cajal in the gastrointestinal tract.” Saudi journal of gastroenterology: official journal of the Saudi Gastroenterology Association 19.1 (2013): 3.
Astolfi, Annalisa, et al. “Whole exome sequencing (WES) on formalin-fixed, paraffin-embedded (FFPE) tumor tissue in gastrointestinal stromal tumors (GIST).” BMC genomics 16.1 (2015): 892.
Boikos, Sosipatros A., et al. “Molecular subtypes of KIT/PDGFRA wild-type gastrointestinal stromal tumors: a report from the National Institutes of Health Gastrointestinal Stromal Tumor Clinic.” JAMA oncology 2.7 (2016): 922-928.
Corless, Christopher L. “Gastrointestinal stromal tumors: what do we know now?.” Modern Pathology 27.S1 (2014): S1.
Hirahara, Noriyuki, et al. “A Novel Technique to Minimize Deformation of the Stomach in Laparoscopic Partial Gastrectomy for Intraluminal Gastric GISTs.” Journal of Laparoendoscopic & Advanced Surgical Techniques, vol. 24, no. 10, Oct. 2014, pp. 707–711.
Huang, Jiang-Long, et al. “Endoscopy-Assisted Laparoscopic Resections for Gastric Gastrointestinal Stromal Tumors: A Retrospective Study.” Journal of Laparoendoscopic & Advanced Surgical Techniques, vol. 27, no. 2, Feb. 2017, pp. 110–114.
Huynh, Thanh-Khoa, et al. “Primary Localized Rectal/Pararectal Gastrointestinal Stromal Tumors: Results of Surgical and Multimodal Therapy from the French Sarcoma Group.” BMC Cancer, vol. 14, no. 1, Mar. 2014, pp. 1–20.
Iorio, N., et al. “Review Article: The Biology, Diagnosis and Management of Gastrointestinal Stromal Tumours.” Alimentary Pharmacology & Therapeutics, vol. 39, no. 12, June 2014, pp. 1376–1386.
Kasetsermwiriya, Wisit, et al. “Laparoscopic Surgery for Gastric Gastrointestinal Stromal Tumor Is Feasible Irrespective of Tumor Size.” Journal of Laparoendoscopic & Advanced Surgical Techniques, vol. 24, no. 3, Mar. 2014, pp. 123–129.
Klein, Sabine, et al. “Interstitial cells of Cajal integrate excitatory and inhibitory neurotransmission with intestinal slow-wave activity.” Nature communications 4 (2013): 1630.
Kramer, Klaus, et al. “Impact of age and gender on tumor related prognosis in gastrointestinal stromal tumors (GIST).” BMC cancer 15.1 (2015): 57.
Lee, Ju-Han, et al. “Correlation of imatinib resistance with the mutational status of KIT and PDGFRA genes in gastrointestinal stromal tumors: a meta-analysis.” Journal of Gastrointestinal & Liver Diseases 22.4 (2013).
Ma, Grace L., et al. “Epidemiology of gastrointestinal stromal tumors in the era of histology codes: results of a population-based study.” Cancer Epidemiology and Prevention Biomarkers 24.1 (2015): 298-302.
Menge, Franka, et al. “Clinical presentation of gastrointestinal stromal tumors.” Visceral medicine 34 (2018).
Rammohan, Ashwin, et al. “A gist of gastrointestinal stromal tumors: A review.” World journal of gastrointestinal oncology5.6 (2013): 102.
Scherübl, Hans, et al. “Management of early asymptomatic gastrointestinal stromal tumors of the stomach.” World journal of gastrointestinal endoscopy 6.7 (2014): 266.
Xiao, Lian, et al. “Meta-Analysis Comparing Laparoscopic versus Open Resection for Gastric Gastrointestinal Stromal Tumors Larger than 5 Cm.” BMC Cancer, vol. 17, Nov. 2017, pp. 1–9.
Ye, Liangying, et al. “Meta-Analysis of Laparoscopic vs. Open Resection of Gastric Gastrointestinal Stromal Tumors.” PLoS ONE, vol. 12, no. 5, May 2017, pp. 1–14.
Yu, Qing-Xiang, et al. “Clinical presentations of gastric, small gastrointestinal stromal tumors mimics functional dyspepsia symptoms.” World journal of gastroenterology: WJG 20.33 (2014): 11800.
Zebary, A., et al. “KIT, NRAS and BRAF mutations in sinonasal mucosal melanoma: a study of 56 cases.” British journal of cancer 109.3 (2013): 559.
Zhu, Yun, et al. “C-kit and PDGFRA gene mutations in triple negative breast cancer.” International journal of clinical and experimental pathology 7.7 (2014): 4280.