I thought it was a stomach ache, but is this GIST cancer? (Gastrointestinal Stromal Tumor)

Do you sometimes just have a stomach ache? Or do you feel unusually tired for no particular reason? Maybe you think it's something to do with what you're eating these days, or maybe it's a case of gastritis. That's what it can be in most cases. But, although rare, these symptoms can also be a sign of a rare, less common cancer. That's what we're going to talk about today. That's GIST, or Gastrointestinal Stromal Tumor. Don't be scared when you hear the name, we'll talk about everything simply and clearly.

Simply put, what is this GIST?

GIST stands for Gastrointestinal Stromal Tumor . Let's break these words down.

• Gastrointestinal: This refers to our digestive system. That is, the path through which the food we eat travels - the mouth, esophagus, stomach, small intestine, and large intestine.
• Stromal: This refers to a special type of tissue found in the walls of our organs and acts as a support for those organs.
• Tumor: You've probably heard of this one. This means a tumor.

Simply put, GIST is a cancerous tumor that starts in a special type of cell in the wall of an organ in our digestive system (most often the stomach or small intestine).

This is a rare type of cancer that belongs to the group of soft tissue sarcomas. In the walls of our intestines, there are special cells called ``interstitial cells of Cajal.`` Think of these cells as the pacemaker of our intestines. These cells help control the rhythmic contractions needed to push food through the intestines. GIST tumors form when there is a defect in these cells, causing them to divide uncontrollably.

These cysts can sometimes be as small as a pencil eraser. When they are small, they can remain for years without showing any symptoms. However, some cysts gradually grow larger and start to cause symptoms that cause us discomfort.

What are the possible symptoms of GIST?

Most of the time, these tumors are found incidentally during a scan or surgery done for another reason, without any symptoms. But if symptoms do occur, they can look like this. Let's put them in an easy-to-understand table .

Why does this GIST develop? What is the cause?

In most cases, the main cause of GIST is a change in one of our genes. Think of the genes in our body as an instruction book for our body to grow and function. There is a page in this instruction book called `(KIT gene)`. According to the instructions on this page, the cells called `(interstitial cells of Cajal)` that we talked about earlier are formed and controlled.

But sometimes, a letter or a word is misspelled on this `(KIT gene)` page. It's like a typing error. In medicine, this is called a `(mutation)`. Because of this mistake, the KIT gene gives the wrong instructions to produce a special protein called `(KIT CD117)`. Because of this wrong protein, those cells constantly get a signal to "keep dividing, keep dividing." That's when those cells grow uncontrollably and form a tumor.

These genetic changes often occur randomly during our lifetimes. That is, they are not something we are born with.

However, very rarely, this condition can be linked to genetic conditions that are passed down from generation to generation. Some of these cases include:

• Familial GIST syndrome: This is a very rare condition. In this case, the child inherits the defective KIT gene from one parent. In this case, GIST tumors may develop at a young age, or more than one tumor may develop.
• Neurofibromatosis type 1: This is also a genetic condition. It causes tumors to form in the body's nerve tissue. People with this condition have a slightly higher risk of developing GIST than the general population.
• Carney-Stratakis syndrome: This is also a very rare, hereditary condition. People with this condition are also at increased risk of developing GIST.

How do doctors diagnose GIST?

When you go to see a doctor with the symptoms mentioned above, he will first ask you about your symptoms. How long they have been present, how they feel, etc. Then he will examine you. In addition, he will recommend several tests to determine the exact cause of the disease.

Main tests performed

• Upper endoscopy: This is often the first test done. Simply put, a tube with a small camera attached to it is inserted through the mouth and the esophagus, stomach, and the first part of the small intestine are examined. This can directly check for tumors and bleeding.
• CT scan: This takes cross-sectional images of the inside of our body. It's like cutting a slice of bread. This can clearly show the size of the tumor, its location, and whether it has spread to other organs, such as the liver.
• Biopsy: This is the most important test to confirm the diagnosis 100%. During the endoscopy or another procedure, a very small piece of tissue is taken from the suspicious tumor. The tissue is then examined under a microscope in a laboratory to see if it is GIST cells.
• PET scan: In some cases, especially if there is a suspicion that the cancer has spread to other parts of the body, this test may be done.

What are the treatments for GIST?

Treatment for GIST depends on the size of the tumor, its location, and whether it has spread to other areas. There are two main types of treatment.

1. Surgery:

In most cases, the best treatment for GIST tumors is to remove the tumor completely with surgery. If the tumor is small and has not spread to other areas, surgery alone can completely cure the disease.

2. Targeted Therapy:

This is the most revolutionary thing about GIST treatment. Unlike regular chemotherapy, these drugs are like "smart bombs." They directly target the defective KIT protein we talked about earlier. Therefore, there is very little damage to healthy cells.

• Before surgery: If the tumor is very large and difficult to operate on, this targeted treatment is given first and then surgery is performed after the tumor has shrunk.
• After surgery: If there is a risk of the disease recurring after surgery, these medications are also given to reduce that risk.
• If the cancer has spread: If the tumor has spread too far to be removed, you may need to take these medications for the rest of your life to control the disease and reduce symptoms.

What can you expect when living with a GIST condition?

After treatment, symptoms may improve, and sometimes the disease may be completely cured. However, GIST is a condition that has a chance of coming back. Therefore, it is very important to stay in touch with your oncologist who will take care of you even after treatment.

You will have follow-up appointments with your doctor every 3 to 6 months. During these times, tests will be done to check for signs of recurrence.

• `CT scans`
• `MRI scans`
• `PET scans`

We do tests like this to make sure everything is okay.

Because GIST is a rare condition, it's normal to feel shocked and scared when you learn about it. But remember, there are now very effective treatments for this condition. You are not alone. Your medical team, family, and friends are all there to help you. Learn about this disease, ask questions, and face treatment positively.

GIST, Gastrointestinal Stromal Tumor, Stomach Cancer, Stomach Cancer, Stomach Tumors, Stomach Pain, Vomiting Blood, Cancer in Sri Lanka