Gastrointestinal stromal tumors (GISTs) are soft tissue sarcomas that can be located in any part of the digestive system. Their most common sites are the stomach and small intestine.

GISTs start in specialized nerve cells located in the walls of your digestive system. These cells are part of the autonomic nervous system. A specific change in the DNA of one of these cells, which control such digestive processes as movement of food through the intestines, gives rise to a GIST.

Small GISTs may cause no symptoms, and they may grow so slowly that they have no serious effects. People with larger GISTs usually seek medical attention when they vomit blood or pass blood in their stool due to rapid bleeding from the tumor.

Other possible GIST symptoms include:

• Anemia, caused by a slow-bleeding tumor
• Abdominal pain
• A growth you can feel in your abdomen
• Nausea
• Vomiting
• Loss of appetite
• Weight loss
• Difficulty swallowing

Diagnosis

• Contrast-enhanced computerized tomography (CT) scan.
• Upper endoscopy.
• Endoscopic ultrasound (EUS).
• Fine-needle aspiration biopsy. 
• Laboratory tests on biopsies.

Treatment

Small, asymptomatic GISTs found in the course of tests for another condition may be approached with watchful waiting in carefully selected cases.

Surgery

Usually, large or symptomatic GISTs are surgically removed unless they are too large or they involve too many organs and tissues for surgery. Resection is also delayed or avoided in people whose general health makes any surgery too risky to undertake, as well as in those likely to have metastatic GISTs.

It's often possible to resect GISTs using minimally invasive surgery, which involves inserting a viewing tube (laparoscope) and surgical instruments through small incisions in the abdomen.

Targeted drug therapy

Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die. For GISTs, the target of these drugs is an enzyme called tyrosine kinase that helps cancer cells grow.

Imatinib (Gleevec) is the first line targeted therapy used to prevent GIST recurrence after surgery. The drug is also used to shrink the tumor before surgery, in situations where surgery isn't possible, as well as for controlling recurrent GIST. Treatment generally continues as long as the drug is effective.

Other drugs that target tyrosine kinase might be recommended if your GIST doesn't respond to or becomes resistant to imatinib over time. Targeted drug therapy is an active area of cancer research and new medications are likely to be available in the future.

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