Gastrointestinal stromal tumors: three decades of lessons

Ranjan Solanki., Shipra., Manish Mishra., Raju Panta., Dragan Jovanovic and Komal Bahadur Gurang

Gastrointestinal stromal tumors have been a diagnostic dilemma to the medical science in the past decades because of the clinical presentation and improper classification. These tumors generally arise in the gastrointestinal tract especially the stomach, however extraintestinal GISTs are not uncommon. The clinical presentation may vary from an indolent to aggressive course depending upon the tumor size, site of involvement, and mitotic figures. The advancements in histopathology, imaging techniques and molecular diagnostics allowed us to know the nature, mutations and biologic behavior of these tumors. Activating mutations of cKIT, PDGFRA or some other downstream key molecules endows the cells of Cajal with the capacity to grow as GIST. These mutant cells are amenable to newer therapeutic regimen, like imatinib mesylate that inhibits activation of the KIT and PDGFα proteins by binding to the adenosine triphosphate binding pocket required for receptor phosphorylation and activation. Apart from drug therapy, surgery is still the only potential curative treatment, if the tumor is amenable to it. Combinations of newer diagnostic techniques, surgical methods, and adjuvant or neoadjuvant therapies have opened doors to treat these cases in a far more efficient way.

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