20%~50% of patients are already in advanced stage when they are first diagnosed. How much do you know about gastrointestinal stromal tumors?

● What is gastrointestinal stromal tumor
Different from gastric cancer and bowel cancer originating from epithelial tissue, gastrointestinal stromal tumor originates from mesenchymal tissue, and is the most common gastrointestinal tumor derived from mesenchymal tissue, accounting for 1% to 3% of all gastrointestinal tumors. The so-called mesenchymal tissue includes connective tissue, adipose tissue, vascular tissue, bone and cartilage tissue, mucus tissue, lymphoid hematopoietic tissue, striated muscle and smooth muscle tissue. The reason why they are divided into mesenchymal tissues is because they all come from the same type of tissues in the embryonic stage.

In addition to gastrointestinal stromal tumors, there are other gastrointestinal tumors derived from mesenchymal tissues, such as gastric leiomyomas, gastric schwannomas, etc., which often appear as submucosal masses in the digestive tract.

● “Magic” gastrointestinal stromal tumor
“Gastrointestinal stromal tumor” is a new medical term officially named and commonly used at the end of the 20th century. From its name, it can be found that it can occur both in the stomach and in the intestines, such as the small intestine and rectum. In fact, it is possible to appear in any part of the digestive tract.

The most common site for gastrointestinal stromal tumors is the stomach, accounting for 60% to 70%. Followed by the small intestine, accounting for 20% to 30%. The colon and rectum account for only 5%, and the esophagus is relatively rare. It is worth mentioning that gastrointestinal stromal tumors can also occur in parts outside the digestive tract, such as the omentum of the abdomen, mesenteric membrane, male prostate, female vagina, etc., which can be said to be “out of sight”.

● How to find gastrointestinal stromal tumors early
Like other tumors, the sooner gastrointestinal stromal tumors are discovered and treated, the better the prognosis will be. This reminds everyone of the need to discover the “cue” of gastrointestinal stromal tumors in time. So, what aspects should we pay attention to?

1. Pay attention to daily physical examination, especially gastroscopy and colonoscopy

The peak age of gastrointestinal stromal tumors is 55-65 years old, and it is relatively rare under 40 years old, and the incidence of men and women is equal. Because it most often occurs in the stomach, many patients with gastrointestinal stromal tumors are detected during gastroscopy, and some patients are discovered accidentally during abdominal surgery. Therefore, it is recommended that people over the age of 40 can add gastroscopy and colonoscopy in their physical examinations every year, and those with conditions can undergo CT or magnetic resonance examinations.

2. See a doctor promptly when symptoms of digestive tract discomfort appear

When the tumor is small, most patients do not have any symptoms. As the tumor grows larger, patients will experience gastrointestinal bleeding, abdominal pain, and sometimes even unable to urinate or defecate. Patients will also have symptoms such as dark urine, black stools, anemia, hematemesis, and some patients will seek medical treatment because of abdominal pain, difficulty swallowing, or touching an abdominal mass. Of course, these symptoms are not specific. Many gastrointestinal diseases have similar symptoms, so the most important thing is to seek medical examination in time when these uncomfortable symptoms appear, so as not to delay the condition.

● How to treat gastrointestinal stromal tumors
1. Surgical treatment

For gastrointestinal stromal tumors, surgery is the most effective treatment. Whether radical surgery can be performed is one of the most important factors affecting the prognosis of patients with gastrointestinal stromal tumors. Except for some gastrointestinal stromal tumors that are smaller than 2 cm and occur in the stomach, they can be followed up under the guidance of a doctor. Other gastrointestinal stromal tumors that occur in the stomach and outside the stomach, or the tumors are found to be enlarged during follow-up All patients should undergo surgery in time after discovery. Complete radical surgery is the preferred method for primary gastrointestinal stromal tumors. 70% to 90% of patients with primary, non-metastasis gastrointestinal stromal tumors can undergo radical surgery.

2. According to the risk classification and genetic test results after the operation, targeted therapy will be carried out under the guidance of the doctor

Clinically, the risk of recurrence of gastrointestinal stromal tumors after surgery is divided into four levels: extremely low risk, low risk, intermediate risk, and high risk according to the size of the tumor, the original site, and whether the tumor is ruptured. Intermediate and high-risk patients are prone to tumor recurrence and metastasis after surgery, so doctors will recommend these patients for targeted therapy after surgery.

Gastrointestinal stromal tumors are not sensitive to conventional radiotherapy and chemotherapy, but since nearly 90% of patients with gastrointestinal stromal tumors have mutations in the c-KIT or PDGFRA gene, they are suitable for targeted drug therapy. General postoperative adjuvant treatment for patients with intermediate-risk gastrointestinal stromal tumors is 1 year, and for patients with intermediate-risk non-gastric gastrointestinal stromal tumors, the postoperative adjuvant treatment is 3 years, and those with ruptured tumors require longer The adjuvant treatment time.

The recurrence rate of gastrointestinal stromal tumors is worthy of attention, especially in high-risk patients, with a recurrence rate of 35% to 95% after surgery. At present, for patients who have relapsed or have metastasis for the first time, targeted drug therapy is the main clinical treatment. It should be noted that even very low-risk or low-risk patients may have recurrence or metastasis during long-term follow-up. Therefore, all patients with gastrointestinal stromal tumors should be followed up for long-term and should not be careless.

3. Some patients need preoperative targeted therapy

Some patients are found late, have huge lumps or have invaded other organs, which will bring great difficulties to the operation. At this time, the surgeon will advise the patient to perform targeted therapy first, and then perform surgery after the mass has shrunk. In this way, the risk of surgery is low, the incidence of postoperative complications is low, and there is no need to remove important organs. At the same time, the tumor can be cut clean, and the effect of the operation is relatively good.

Early detection of gastrointestinal stromal tumors and timely standard treatment can greatly reduce the harm caused by the disease. Since the application of targeted drugs in the treatment of gastrointestinal stromal tumors, the median survival time of patients with gastrointestinal stromal tumors that have recurred, metastasized or cannot be treated surgically has increased from 1.5 years to more than 5 years, and even 20% of patients’ The survival time can exceed 10 years.