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Getting the Gist of Gastrointestinal Stromal Tumors

July 12, 2019

In recognition of Gastrointestinal Stromal Tumor Awareness Day, held annually on July 13, Declan Fleming, M.D., FACS, of Texas Oncology Surgical Specialists–Austin Central and Round Rock discusses gastrointestinal stromal tumors (GISTs), and their treatments.

What are gastrointestinal stromal tumors, and how common are they?

Gastrointestinal stromal tumors (GISTs) are soft tissue sarcomas of the gastrointestinal (GI) tract. They’re primarily diagnosed in middle-aged and older individuals, and are often asymptomatic – meaning they’re usually discovered while scanning the abdomen or elsewhere for another health condition. Overall, the clinical diagnosis of GISTs is rare – only about 4,500 people in the United States are expected to be diagnosed with the condition this year.

What role does surgery play in the treatment of GISTs, alongside treatments like targeted therapy?

Surgery is the primary treatment for almost every GIST and offers the only opportunity for a cure. Any GIST that is greater than 2 centimeters in size that can safely be removed surgically should be removed.

The development of newer surgical technologies, such as minimally-invasive surgery, have improved surgical outcomes for some patients with GISTs. The most significant change in their treatment over the past several years has been the discovery of the exquisite sensitivity of most GISTs to targeted tyrosine kinase inhibitor (TKI) therapy, a drug that helps block the action of certain enzymes that would otherwise spark cancer cell growth. 

Since GISTs respond well to targeted therapy with TKI medications. Large tumors or those that require a complicated surgery may, in many cases, shrink with preoperative therapy. This type of treatment may dramatically increase the likelihood of a person being able to undergo a surgery with fewer surgery-related, long-term side effects.

Earlier in my career, patients with metastatic disease from GISTs often expected lower survival rates. Today, even in patients whose tumors grow despite treatment with first-line TKI therapy, there are several additional medical therapies that can be very effective. 

What do you think is vital for patients to know about GISTs?

It’s important to remember that complete surgical removal of the GIST is the most effective form of treatment, but additional medical therapy significantly reduces the risk of recurrence. A multidisciplinary team of physicians that provide a coordinated approach to the treatment of GISTs offers the best opportunity for long-term survival and a good quality of life. At Texas Oncology, this is what we strive to provide our patients.

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