Gastrointestinal Stromal Tumor (GIST): when can we think about it?

Gastrointestinal Stromal Tumor (GIST): when can we think about it?

We can do a little 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. 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. 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.”  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.

Although there is no much about the risk factors of GIST, it affects most old people between 40 and 80 years. Also, there is a rare uninherited risk factor, a gene mutation with chances of developing GIST.  Another risk factor is the primary familial GIST syndrome, a condition which is inherited. 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 which a child gets from parents. 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. 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. 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. Also, a patient may have blood on the stool or experience acute hematemesis.

How a primary care doctor or a gastroenterologist can exclude more common cause and after 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. GIST is one cause of inactiveness in ICCs, which may make the IG muscle cells unable to respond.

GIST prevents mutation in KIT genes. The inhibition increases the symptoms of dyspepsia. 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 function of some cells once it receives signals. 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.

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.  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. The condition occurs when GIST from the GI metastasize in an abnormal way to the abdominal wall. 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 huge sizes. Also, they have many blood vessels around them. 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.


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