From the Guidelines
Gastrointestinal stromal tumors (GISTs) can lead to several serious complications, including gastrointestinal bleeding, bowel obstruction, tumor rupture, and metastasis, which can significantly impact morbidity, mortality, and quality of life. The most common symptoms of GIST include upper gastrointestinal bleeding and anemia, whilst larger tumors may present with abdominal pain/discomfort and a palpable mass 1. Small bowel GISTs may remain silent for a long period before presenting with an acute event such as hemorrhage or rupture. Symptomatic rectal GISTs may present with pain, obstruction, and bleeding; oesophageal and gastro-oesophageal junction GISTs with dysphagia. Some patients may have non-specific systemic symptoms e.g. weight loss, night sweats, and fever.
Common Complications
- Gastrointestinal bleeding, which may present as hematemesis, melena, or occult bleeding leading to anemia
- Bowel obstruction due to tumor growth blocking the digestive tract
- Tumor rupture, which can cause severe abdominal pain and peritonitis requiring emergency surgery
- Metastasis, with GISTs most commonly spreading to the liver and peritoneum
Diagnosis and Treatment
According to the British Sarcoma Group clinical practice guidelines, a pre-operative diagnosis is preferable to exclude differential diagnoses, and molecular analysis has predictive value for sensitivity to molecular-targeted therapy, and prognostic value 1. The inclusion of KIT/PDGFRA molecular analysis in the diagnostic work-up of all GISTs is highly recommended. Patients with GISTs which show clinicopathological features suggestive of SDH deficiency should also have IHC for SDHB and if negative, testing for sporadic or germline SDH mutation/epigenetic loss.
Management and Follow-up
Long-term survivors require regular monitoring with CT scans or MRIs every 3-6 months initially, then annually after 5 years, to detect recurrence early. Nutritional deficiencies may develop, particularly after extensive gastric resections, potentially requiring vitamin B12 supplementation. It is essential to prioritize a multidisciplinary approach to manage GISTs, including surgery, systemic treatment, and regular follow-up to minimize complications and improve quality of life.
From the FDA Drug Label
(5.5) Grade 3/4 hemorrhage has been reported in clinical studies in patients with newly diagnosed CML and with GIST. GI tumor sites may be the source of GI bleeds in GIST.
Table 3 Adverse Reactions Reported in ≥ 10% of GIST Patients Who Received Sunitinib in the Double-Blind Treatment Phase and More Commonly Than in Patients Given Placebo* in Study 1 ... Gastrointestinal Diarrhea 40 4 Mucositis/stomatitis 29 1 Constipation 20 0 ... Hemorrhagic Events [see Warnings and Precautions (5.5)]
GIST tumor complications include:
- Hemorrhage: Grade 3/4 hemorrhage has been reported in clinical studies in patients with GIST, with GI tumor sites potentially being the source of GI bleeds.
- Gastrointestinal symptoms: Diarrhea, mucositis/stomatitis, and constipation have been reported in patients with GIST receiving sunitinib.
- Other adverse reactions: Fatigue, hypertension, asthenia, hand-foot syndrome, and nausea have also been reported in patients with GIST receiving sunitinib 2 3.
From the Research
Gist Tumor Complications
- Gastrointestinal stromal tumors (GISTs) are rare neoplasms of the gastrointestinal tract associated with high rates of malignant transformation 4.
- The most frequent symptoms of GISTs are anemia, weight loss, gastrointestinal bleeding, abdominal pain, and mass-related symptoms 5.
- Patients may present with acute abdomen, obstruction, perforation, or rupture and peritonitis 5.
- GISTs can cause complications such as:
- High-risk tumors should be monitored for recurrence with serial abdominal CT scans 4.
- Metastasis formation is a significant complication, with 14.4% of patients having either synchronous or metachronous metastases, even in the low-risk group 6.
- The development of secondary neoplasias is also a considerable risk, with 31% of patients having associated malignant neoplasms 6.