Gastrointestinal stromal tumor natural history

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]

If left untreated, patients with gastrointestinal stromal tumors (GIST) may progress to develop abdominal pain, abdominal distension and perforation. A benign GIST may remain unchanged for years before its progression into malignancy. A GIST may rupture and lead to intra-abdominal or gastrointestinal bleeding. Ultimately, the GIST may metastasize and turn fatal. Common complications of GIST include bowel obstruction, bowel perforation, and peritonitis. Depending on the extent of the tumor at the time of diagnosis, the prognosis of GIST may vary. Prognosis of GIST depends upon size, location, spread and mitotic rate of the tumor. A benign GIST treated with surgical resection has much more better outcome as compared to patients with malignant GIST.

• Around 75% patients of gastrointestinal stromal tumors (GIST) are asymptomatic and are diagnosed as an incidental finding on imaging studies done for other reasons.
• If left untreated, patients with GIST may progress to develop abdominal pain, abdominal distension and perforation.
• Depending upon the type of GIST (benign or malignant), a benign GIST may remain unchanged for years before its progression into malignancy.^[1]
• GIST are highly vascular and an untreated tumor may attain massive size leading to rupture and intra-abdominal or gastrointestinal bleeding.
• A ruptured GIST may lead to coffee ground emesis, black stools or even melena.
• Ultimately, the GIST may metastasize and turn fatal.

Common complications of GIST include:^[2]

• Gastrointestinal bleeding
• Bowel obstruction
• Bowel perforation
• Peritonitis
• Volvulus
• Intussusception
• Surgical complications associated with resection include:
  • Atelectasis
  • Pneumonia
  • Urinary tract infection
  • Abscess formation
  • Small-bowel obstruction
  • Deep venous thrombosis

• Depending on the extent of the tumor at the time of diagnosis, the prognosis of GIST may vary.^[3]
• Prognosis of GIST depends upon size, location, spread and mitotic rate of the tumor (mitoses per 50 high-power fields).^{[4][5][6][7][8]}
  • Patients with gastric GIST have been reported to have better outlook as compared to patients with extragastric GIST.
  • Patients with localized primary disease have a average survival period of 5 years.
  • Patients with malignant lesions and metastasis have an average survival period of 1-2 years.
  • Patients with mitotic rate of >10 per 50 HPF have an average survival period of 1.5-2 years
  • Patients with mitotic rate <10 per HPF have an average survival period of 8 years.

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