Stomach cancer GIST, who can survive, who can guarantee death?

The Department of Gastroenterology – Hepatobiliary Surgery, Bach Mai Hospital has just successfully operated on 2 cases of gastric GIST that developed into a malignant tumor with large size (20-30cm in diameter, 5kg in weight). Sadly, because the patient was not treated in time, it left unfortunate consequences

The first case is patient N, 47 years old male. History of gastritis for many years, infrequent treatment. About the last 6 months, the patient feels pain in the epigastrium, or fullness in the abdomen, eating less.

The patient bought himself medicine to treat gastritis but did not get better, until he felt the mass in the epigastrium himself, he decided to go to the Department of Gastroenterology – Hepatobiliary and pancreatic surgery, Bach Mai Hospital and was diagnosed: GIST stomach, however, the tumor was large, at a late stage, so it invaded the body of the tail of the pancreas.

Image of gastric GIST mass with tail body of pancreas and spleen after being removed from the abdomen of patient N.

The patient had to undergo a major surgery: open surgery to remove the whole mass including the entire stomach, tail body of pancreas and spleen, complicated surgery, although it took place with unexpected success, but the next step for Mr. will be difficult. Risk of disease recurrence or metastasis…

The second case is a patient NQT, 62 years old, with a history of gastritis for more than 10 years with occasional treatment. About 4 years ago, Mr. T felt a dull ache in his epigastrium, thinking he still had gastritis, so he went to the pharmacy to buy medicine to drink. After using the drug, the symptoms are slightly relieved, but not cured.

After a year, Mr. T noticed that his belly was getting bigger, but he thought that his belly fat was due to fat accumulation, Mr. T ate less to lose weight, his weight did not increase, but his belly was still getting bigger.

Until the last 3 months, Mr. T had a feeling of fullness and discomfort when he ate, his stomach had a hard mass even when he was hungry, so Mr. T decided to go to a private hospital in Son La city.

Here he was diagnosed with a small bowel tumor and was transferred to Son La Provincial General Hospital for further treatment. Here, the patient was assessed as a complicated case, so he was transferred to Bach Mai Hospital.

At Bach Mai Hospital, he was diagnosed with gastric GIST and was assigned surgery at the Department of Gastrointestinal Surgery – Hepatobiliary tract. The surgery is expected to be difficult, complicated, and possibly even impossible.

However, under the determination and efforts of experienced surgeons and the coordination of anesthesiologists, after 3 hours of intense concentration, the surgical team was able to cut the giant tumor. more than 30 cm in diameter, 5 kg in weight, and almost all of Mr. T’s stomach without damaging the surrounding organs.

Tumor with a mass of nearly 5 kg was removed from the abdomen of patient T.

Now, after a stable postoperative period, Mr. T has gradually recovered. He regrets that if he had gone to the doctor sooner when he saw something abnormal or had a regular medical check-up, he could have detected the disease early and the surgery would have been much simpler.

GIST is the English abbreviation of the phrase “Gastrointestinal Stromal Tumor”, which is a tumor that originates from the stroma of the stomach.

The stomach structure consists of 6 layers: the innermost lining is the mucosa – where the common type of stomach cancer originates (carcinoma); the second and fourth layers of the stomach are called the myocardium and the muscularis, which help push food from the stomach into the small intestine; the fifth and sixth layers are the subserosa and the serosa forms the sheath of the stomach; the third layer – the submucosa is the stroma.

The stroma is defined as “the supporting framework of an organ made up of connective tissue” – can be understood as the rough part of a house, helping to shape the house and support the details. techniques such as wires, supply and drainage pipes… so that the house has a characteristic shape and the equipment inside can be operated.

Similarly, the supporting framework (stroma) of the stomach is made up of connective tissue, through which the nerves and blood vessels operate, allowing the stomach to function through the domination of the interstitial cells of Cajal, Acts as a pacemaker, forcing the muscles to contract, pushing food from the stomach into the small intestine and then to the large intestine.

Gastrointestinal stromal tumors (GISTs) are thought to arise from Cajal interstitial cells or their precursors. Because the tumor originates in the middle layer of the stomach, the tumor can grow inward, penetrate the lining of the stomach and cause gastrointestinal bleeding; Tumors can also grow outward, in this case, there may be no early symptoms, except for pain.

GIST is more common in young people and in the stomach, but in rare cases it can be in the intestines or esophagus. Unlike other cases of stomach cancer, even if detected early, it is also cancerous, gastric GIST (or gastrointestinal GIST in general) at an early stage is mostly benign.

Patients may present with symptoms such as abdominal pain, gastrointestinal bleeding, but may also be asymptomatic and discovered incidentally during physical examination. Prognosis of gastric GIST has an increased risk with tumor size. Tumors smaller than 2cm have low risk, tumors between 2 and 5cm have medium risk, and tumors over 5cm have a high risk of developing malignancy.

Detecting the tumor as early as possible when the tumor size is small will help the patient have a higher chance of less invasive and radical treatment in terms of oncology, for example, when the tumor is less than 5cm, the patient can have endoscopic surgery. endoscopic tumor resection, no need to cut the stomach, many cases do not need adjuvant chemotherapy after surgery. However, to detect early when the tumor size is small, there are no symptoms is not easy. Therefore, the role of cancer screening and screening is very important.

Therefore, doctors of the Department of Gastroenterology – Hepatobiliary and Pancreatic Surgery recommend that patients should go to the doctor immediately if there are abnormal symptoms such as loss of appetite, bloating, unexplained weight loss, small stools. flatulence, bloody stools, constipation or diarrhea…

Screening for cancer of the gastrointestinal tract (stomach, colorectal) periodically at reputable medical facilities, even if the body does not appear the above signs. In particular, pay attention to people in high-risk groups such as: People over 45 years old; Individuals or family members with a history of intestinal diseases, colorectal polyps, colorectal cancer, stomach cancer; People who often suffer from constipation, bloody stools of unknown cause; People with unhealthy eating and drinking lifestyles, often smoking, drinking alcohol; People with diseases related to digestive tract damage: atrophic gastritis, ulcerative colitis, Crohn’s disease.

N. Huyen