Presentation, Biologic Behavior, and Short-Term Management Outcome of Gastrointestinal Stromal Tumors

Abstract

Background: The most common mesenchymal tumors of the gastrointestinal tract are called gastrointestinal stromal tumors (GISTs). They are thought to develop from the neoplastic transformation of intestinal pacemaker cells, which are often present in the intestine wall or their ancestors. One to three per cent of all GI neoplasms are GISTs. GISTs and carcinomas are not the same. Their characteristics influence surgical management. Objectives: To see the presentations, biological behaviour, and short-term management outcome of gastrointestinal stromal tumors. Methodology: The study is an observational study conducted from January to June 2018 in the Department of Surgery of Dhaka Medical College Hospital (DMCH), Bangabandhu Sheikh Mujib Medical University (BSMMU), Mitford Hospital, Suhrawardi Medical College Hospital, and BIRDEM. The study population includes patients admitted with GIST, and 30 respondents were interviewed through a structured questionnaire. Results: In the study, gastrointestinal stromal tumors (GISTs) commonly presented with generalized weakness (the most frequent symptom), followed by abdominal pain in 80% of cases. Other presentations included asymptomatic or incidentally diagnosed cases (50%), acute abdomen due to perforation (40%), upper GI bleeding (43.33%), palpable abdominal lump (36.67%), vomiting (23.33%), intestinal obstruction (10%), and per rectal bleeding (10%).The tumors varied in size, with eight cases ranging from 5 to 10 cm, and most tumors were larger than or equal to 10 cm. Risk assessment classified 13 cases as high risk and 7 as low risk. In terms of outcomes, 7 patients died, 43.33% lived with recurrent or metastatic disease, and 13.33% survived without recurrence or metastasis. Additionally, 6 patients were lost to follow-up after surgery. Conclusion: Common clinical features include anaemia, abdominal pain, upper gastrointestinal bleeding, palpable abdominal mass, and generalized weakness. The preferred treatment choices are immunotherapy and total resection from the surgical margins, with surgical resection being the most common approach.