GIST
•
3 likes•36 views
A undergraduate level summary of gastrointestinal stromal tumor (GIST) describing its clinical features, pathology and management.
Report
Share
Report
Share
Recommended
Annular Pancreas: An Unusual Presentation
Annular pancreas is an uncommon condition in adults.
The ring formation generally originates from the failure of
normal clockwise rotation of ventral pancreas. First
described by Tiedmann in 1818, its incidence is
1:20,000 population. It has bimodal presentation i.e is seen
either in Infants or in 4th & 5th decade of life.
Liver trauma
This document discusses liver trauma, including:
- The liver is prone to blunt injury due to its friable parenchyma and fixed position. Right lobe injuries are more common.
- Mechanisms of injury include blunt trauma from the ribs/spine, high-velocity bullets, stab wounds, and medical procedures.
- Associated injuries occur in 45% of blunt trauma cases and 33% with rib fractures.
- Injuries range from subcapsular hematomas to lacerations to devascularization. Severe injuries take 9-15 months to heal.
- Clinical signs include blood loss, abdominal tenderness, and delayed abscess. Imaging like CT scan is used to diagnose and monitor healing.
Retroperitoneal fibrosis
This document provides information about retroperitoneal fibrosis (RPF), including its pathogenesis, clinical presentations, investigations, and management. RPF is characterized by extensive fibrosis in the retroperitoneum that can encase the aorta, vena cava, and ureters. Patients typically present with nonspecific symptoms like back pain, but late presentations can include urinary obstruction and vascular complications. Diagnosis is often made using CT or MRI imaging showing soft tissue surrounding retroperitoneal structures. Treatment involves medications like corticosteroids to reduce inflammation or surgical procedures to decompress the urinary system if obstructed.
Hepatocellular Carcinoma- At a Glance
Hepatocellular carcinoma (HCC) is the most common type of liver cancer. It has a high worldwide incidence, especially in areas where hepatitis B is prevalent like Southeast Asia. Major risk factors for HCC include hepatitis B and C infections, cirrhosis of the liver from any cause, and alcohol abuse. The disease progresses as hepatocytes undergo repeated cycles of cell death and regeneration due to chronic inflammation and cirrhosis, accumulating mutations over time that can lead to cancer. Diagnosis involves blood tests, imaging like ultrasound or CT scan, and often a biopsy. Staging systems evaluate tumor characteristics, liver function, and physical status to determine prognosis and treatment options. Treatment may include surgical resection, liver transplantation, ablation
Benign tumors of the Liver
Brief description on the benign tumors of liver that includes hemangioma, focal nodular hyperplasia, regenerative nodular hyperplasia, dysplastic foci, dysplastic nodules and focal fatty change.
Surgical Management Of Diverticular Disease
This document summarizes the surgical management of diverticular disease based on a literature review. It describes different stages of diverticular abscesses and appropriate treatment approaches. For smaller abscesses, antibiotics or CT-guided drainage may be sufficient, while larger abscesses often require drainage followed by elective surgery. The document also discusses approaches to acute diverticulitis, obstruction, and fistulas, noting debates around conservative versus operative management.
Cholangiocarcinoma
This document provides an overview of cholangiocarcinoma including its epidemiology, risk factors, molecular pathology, tumor classification, clinical presentation, diagnosis, and treatment. Some key points:
- Cholangiocarcinoma arises from the epithelial cells of the bile ducts and can be intrahepatic, perihilar, or distal.
- Risk factors include primary sclerosing cholangitis, parasitic infections, cholelithiasis, hepatitis, and toxins.
- Clinical presentation is usually jaundice. Diagnosis involves blood tests of tumor markers like CEA and CA19-9 and imaging studies.
- Tumor classification is based on extent of involvement
Carcinoma of esophagus
This document discusses esophageal cancer, including:
- It remains the 6th most common malignancy and rates vary globally. Squamous cell carcinoma is most common.
- Risk factors include smoking, alcohol, hot liquids and micronutrient deficiencies. Barrett's esophagus increases adenocarcinoma risk.
- Symptoms depend on location and stage but include dysphagia, weight loss, pain and cough.
- Diagnostic tools include endoscopy, CT, PET, MRI and EUS to determine stage.
- Treatment involves chemotherapy, radiation, and surgery depending on location and stage. Surgical techniques include transhiatal, Ivor Lewis and minimally invasive approaches.
Recommended
Annular Pancreas: An Unusual Presentation
Annular pancreas is an uncommon condition in adults.
The ring formation generally originates from the failure of
normal clockwise rotation of ventral pancreas. First
described by Tiedmann in 1818, its incidence is
1:20,000 population. It has bimodal presentation i.e is seen
either in Infants or in 4th & 5th decade of life.
Liver trauma
This document discusses liver trauma, including:
- The liver is prone to blunt injury due to its friable parenchyma and fixed position. Right lobe injuries are more common.
- Mechanisms of injury include blunt trauma from the ribs/spine, high-velocity bullets, stab wounds, and medical procedures.
- Associated injuries occur in 45% of blunt trauma cases and 33% with rib fractures.
- Injuries range from subcapsular hematomas to lacerations to devascularization. Severe injuries take 9-15 months to heal.
- Clinical signs include blood loss, abdominal tenderness, and delayed abscess. Imaging like CT scan is used to diagnose and monitor healing.
Retroperitoneal fibrosis
This document provides information about retroperitoneal fibrosis (RPF), including its pathogenesis, clinical presentations, investigations, and management. RPF is characterized by extensive fibrosis in the retroperitoneum that can encase the aorta, vena cava, and ureters. Patients typically present with nonspecific symptoms like back pain, but late presentations can include urinary obstruction and vascular complications. Diagnosis is often made using CT or MRI imaging showing soft tissue surrounding retroperitoneal structures. Treatment involves medications like corticosteroids to reduce inflammation or surgical procedures to decompress the urinary system if obstructed.
Hepatocellular Carcinoma- At a Glance
Hepatocellular carcinoma (HCC) is the most common type of liver cancer. It has a high worldwide incidence, especially in areas where hepatitis B is prevalent like Southeast Asia. Major risk factors for HCC include hepatitis B and C infections, cirrhosis of the liver from any cause, and alcohol abuse. The disease progresses as hepatocytes undergo repeated cycles of cell death and regeneration due to chronic inflammation and cirrhosis, accumulating mutations over time that can lead to cancer. Diagnosis involves blood tests, imaging like ultrasound or CT scan, and often a biopsy. Staging systems evaluate tumor characteristics, liver function, and physical status to determine prognosis and treatment options. Treatment may include surgical resection, liver transplantation, ablation
Benign tumors of the Liver
Brief description on the benign tumors of liver that includes hemangioma, focal nodular hyperplasia, regenerative nodular hyperplasia, dysplastic foci, dysplastic nodules and focal fatty change.
Surgical Management Of Diverticular Disease
This document summarizes the surgical management of diverticular disease based on a literature review. It describes different stages of diverticular abscesses and appropriate treatment approaches. For smaller abscesses, antibiotics or CT-guided drainage may be sufficient, while larger abscesses often require drainage followed by elective surgery. The document also discusses approaches to acute diverticulitis, obstruction, and fistulas, noting debates around conservative versus operative management.
Cholangiocarcinoma
This document provides an overview of cholangiocarcinoma including its epidemiology, risk factors, molecular pathology, tumor classification, clinical presentation, diagnosis, and treatment. Some key points:
- Cholangiocarcinoma arises from the epithelial cells of the bile ducts and can be intrahepatic, perihilar, or distal.
- Risk factors include primary sclerosing cholangitis, parasitic infections, cholelithiasis, hepatitis, and toxins.
- Clinical presentation is usually jaundice. Diagnosis involves blood tests of tumor markers like CEA and CA19-9 and imaging studies.
- Tumor classification is based on extent of involvement
Carcinoma of esophagus
This document discusses esophageal cancer, including:
- It remains the 6th most common malignancy and rates vary globally. Squamous cell carcinoma is most common.
- Risk factors include smoking, alcohol, hot liquids and micronutrient deficiencies. Barrett's esophagus increases adenocarcinoma risk.
- Symptoms depend on location and stage but include dysphagia, weight loss, pain and cough.
- Diagnostic tools include endoscopy, CT, PET, MRI and EUS to determine stage.
- Treatment involves chemotherapy, radiation, and surgery depending on location and stage. Surgical techniques include transhiatal, Ivor Lewis and minimally invasive approaches.
Pancreatic Trauma
The document discusses pancreatic trauma, including relevant anatomy, epidemiology, etiology, presentation, workup, staging, and treatment. Some key points:
- The pancreas is protected by surrounding structures but can be injured by penetrating trauma or direct blunt force.
- Injury is staged based on severity from grade I (minor) to grade V (massive disruption). Treatment depends on grade and location of injury.
- Workup may include labs, CT, MRCP, ERCP. Surgical treatment ranges from observation for minor injuries to distal pancreatectomy or pancreaticoduodenectomy for more severe injuries.
- Complications include pancreatic fistula, abscess, and pseudocyst.
Colonic polyposis syndromes
Colonic polyposis refers to numerous polyps throughout the GI tract that are often precancerous. The most common type is familial adenomatous polyposis (FAP), an autosomal dominant condition caused by a mutation in the APC gene. People with FAP develop hundreds to thousands of colon polyps by their mid-30s, and colon cancer is inevitable without surgery to remove the colon. They are also at risk of polyps in the stomach and duodenum that can become cancerous. Treatment involves prophylactic colectomy, surveillance of the upper GI tract, and managing extracolonic manifestations such as osteomas and desmoid tumors.
Biliary stricture ppt
Biliary stricture is an abnormal narrowing of the bile duct. The most common cause is injury during cholecystectomy, accounting for 80% of non-malignant strictures. Bile duct injury can cause inflammation, fibrosis, scarring, and cirrhosis. Surgical treatment depends on when the injury is recognized, with immediate repair during surgery or delayed repair weeks later being options. Roux-en-Y hepaticojejunostomy is a common repair method that involves a mucosa-to-mucosa anastomosis of the bile duct to the jejunum. Factors like multiple prior repairs, proximal strictures, and surgeon inexperience can lead to poor outcomes.
Stomach pathology lecture
The normal gastric mucosa contains mucus-secreting cells in the cardia, acid-producing and pepsin-producing cells in the fundus and body, and hormone-producing cells in the pylorus. The stomach functions to mix and start digestion of food, activate enzymes, destroy bacteria, and absorb nutrients, alcohol, water, and vitamins. Common pathologies of the stomach include peptic ulcers, gastritis, tumors, and congenital anomalies like pyloric stenosis. Chronic gastritis is often caused by H. pylori infection and can lead to atrophy, intestinal metaplasia, and increased cancer risk over time if not treated.
Common bile duct stone
This case presentation describes a 34-year-old female patient who presented with right upper quadrant pain. She had a history of epigastric pain radiating to the back for 6 days along with jaundice. Imaging showed choledocholithiasis and cholecystolithiasis. She underwent open cholecystectomy with intraoperative cholangiogram, common bile duct exploration, and T-tube placement. Her postoperative course was uncomplicated and she was discharged with a T-tube in place.
Cystic pancreatic lesions
This document provides guidelines for the diagnosis and management of cystic pancreatic lesions. It discusses various types of cystic masses that can occur in the pancreas such as pseudocysts, serous cystadenomas, mucinous cystic neoplasms, intraductal papillary mucinous neoplasms (IPMN), and solid pseudo-papillary tumors. For each type, it provides information on characteristics, malignant potential, imaging appearance, and treatment approach. Initial evaluation of pancreatic cysts should aim to exclude pseudocysts based on history of pancreatitis. Morphological evaluation and cyst fluid analysis via EUS and FNA are important diagnostic tools to characterize cyst type and guide management.
Diverticulosis and diverticular disease
This document discusses diverticular disease, specifically diverticulosis and acute diverticulitis. It covers the epidemiology, pathophysiology, clinical presentation, investigations including CT and barium enema, differential diagnosis, and Hinchey classification of diverticulitis severity. Diverticulosis is asymptomatic protrusions in the colon wall that become symptomatic as diverticulitis in 20% of cases from obstruction, inflammation, or perforation. Risk factors include low fiber diet and increased age. CT is the best imaging method to diagnose and stage diverticulitis.
Acute Variceal Hemorrhage
This document provides definitions and background information about acute variceal hemorrhage. It defines acute variceal bleeding as hematemesis or melena within the last 48 hours in a known or suspected case of portal hypertension. Varices are the accepted source of bleeding if blood is seen arising from or clotted on top of an esophageal varix. Failure to control the bleeding is defined as rebleeding within 48 hours of treatment. The document discusses the anatomy of varices, risk factors for bleeding such as varix size, and complications associated with acute variceal hemorrhage such as high rebleeding and mortality rates.
Diagnosis and Treatment of Ascites
This document provides guidelines for the diagnosis and treatment of ascites. It defines ascites as fluid collection in the abdominal cavity, with cirrhosis being the most common cause, accounting for 80% of cases. The development of ascites in cirrhosis is associated with poor prognosis and impaired quality of life. Diagnostic evaluation of ascites involves abdominal ultrasound and diagnostic paracentesis of ascitic fluid. Treatment involves dietary salt restriction, diuretics such as spironolactone and furosemide, and therapeutic paracentesis for large volume ascites. Albumin administration is recommended with large volume paracentesis to prevent circulatory dysfunction. Refractory ascites that does not respond to medical therapy may require interventions
Gastric cancer management
This document discusses treatment options for gastric cancer, including surgery, chemotherapy, and radiation therapy. It covers various lymph node dissection classifications (D0-D2) and their roles in different stages of disease. Adjuvant therapies like chemotherapy and chemoradiation are recommended after surgery to improve survival outcomes. Perioperative and postoperative chemotherapy are supported by clinical trials to be beneficial in resectable gastric cancer.
Cholangiocarcinoma
- Cholangiocarcinoma is a rare cancer that affects the bile ducts. It can originate in the intrahepatic, perihilar, or distal bile ducts.
- Risk factors include primary sclerosing cholangitis, parasitic infections, hepatolithiasis, and viral infections like HCV and HBV.
- Diagnosis involves blood tests, imaging like MRI/MRCP and ERCP, and biopsy. Surgery is the main treatment for resectable tumors while chemotherapy may be given for unresectable cases. The prognosis is poor even after resection due to high recurrence rates.
Esophageal varices
esophageal varices are the second most common cause of upper GI bleed after PUD.These are actually the dilated veins which occur secondary to increase in the pressure in the portal circulation called as Portal Hypertension..
Hepatocellular carcinoma
This document discusses hepatocellular carcinoma (HCC), the most common type of primary liver cancer. It covers the epidemiology, risk factors, pathogenesis, clinical presentation, diagnosis, prognostic factors, and treatment options for HCC. The highest rates are seen in regions where hepatitis B is endemic, and major risk factors include chronic hepatitis B and C infections, cirrhosis, and aflatoxin exposure. Diagnosis involves imaging tests like ultrasound, CT, and MRI along with blood tests. Treatment depends on tumor size and liver function, and may include resection, transplantation, ablation, embolization, or chemotherapy.
Anal cancer ppt
The anal canal is approximately 4 cm in length extending from the anorectal junction to the anal verge. Anal cancers are rare and mostly squamous cell carcinomas arising from the anal transitional zone. Risk factors include HPV infection and immunosuppression. Combined chemoradiotherapy is the standard first-line treatment and results in high response rates and organ preservation compared to radiation alone. Salvage surgery may be considered for select cases after failed nonsurgical treatment or as primary treatment for those who cannot tolerate chemoradiotherapy. Prognosis depends on tumor stage, with 5-year survival rates ranging from 45-86% depending on depth of invasion and nodal involvement.
CBD stones/ Choledocholithiais / Biliary stones
The document discusses the management of choledocholithiasis or common bile duct stones. It covers the clinical features, investigations like ultrasound, CT, ERCP and MRCP. It discusses the diagnostic approach and various management options including endoscopic procedures like ERCP with sphincterotomy and plastic stent placement. It also discusses open CBD exploration techniques like choledochotomy and T-tube placement. Laparoscopic CBD exploration is mentioned as a minimally invasive method. Guidelines recommend ERCP as first-line treatment for CBD stones with timing based on severity of cholangitis. Sphincterotomy with balloon dilation and cholangioscopy-assisted lithotripsy are suggested for difficult stones.
Evidence Based Treatment of Acute Pancreatitis 2013
The document summarizes guidelines for the diagnosis and management of acute pancreatitis. It addresses criteria for diagnosis, risk stratification based on severity (mild, moderately severe, severe), initial assessment including fluid resuscitation goals, nutritional support, and recommendations for enteral versus parenteral nutrition based on severity. The guidelines emphasize early aggressive fluid resuscitation, monitoring for organ failure, and initiating enteral nutrition in severe cases to prevent infectious complications while avoiding parenteral nutrition.
Gallstones
Powerpoint Presentation briefly describing Gallstones and its etiology, risk factors, as well as complications.
Benign tumor of liver : Hepatocellular origin
Benign tumor of liver : Hepatocellular origin that includes Adenoma, dysplastic nodule,focal nodular hyperplasia and others
Renal cell carcinoma
A 46-year-old female presented with left lumbar pain radiating to the left leg for 1 month. Imaging revealed a large renal cell carcinoma arising from the left kidney. She underwent renal tumor embolization followed by a left radical nephrectomy. Her postoperative course was unremarkable and her biopsy confirmed chromophobe renal cell carcinoma. She was discharged on medications and advised follow up with the urologist and biopsy results. Renal cell carcinoma accounts for 3% of adult cancers and is more common in males. Presentation may include flank pain, mass, or hematuria. Treatment involves surgery, radiation, targeted drug therapies, and immunotherapy depending on stage. Prognosis depends on stage, with earlier stages
Cholangiocarcinoma ppt
This document provides information on cholangiocarcinoma (CC), a type of cancer that forms in the bile ducts. It discusses the anatomy and classification of CC, as well as risk factors like primary sclerosing cholangitis. Symptoms of CC include jaundice, abdominal pain, and weight loss. Diagnosis involves blood tests, imaging like MRI/MRCP, and tissue sampling. CC is staged according to tumor involvement. Treatment may include surgery if possible, with palliative options for unresectable disease like stenting. Prognosis depends on stage, with early stage having higher survival rates.
Pancreratic Endocrne Tumors.pptx
1. Pancreatic endocrine tumors (PETs) are rare neuroendocrine tumors that arise from pancreatic islet cells. They include functional tumors like insulinomas and gastrinomas, as well as non-functional PETs.
2. Insulinomas are the most common functional PET and cause hypoglycemia. Diagnosis involves demonstrating inappropriate insulin levels during hypoglycemia. Surgical resection is usually curative.
3. Gastrinomas cause Zollinger-Ellison syndrome with severe peptic ulcer disease. They are often malignant and surgical resection offers the best chance of cure if localized.
MANAGEMENT 0F SEMINOMA CURRENT STATUS AND FUTURE DIRECTIONS.pdf
1) Seminoma is the most common germ cell tumor in young males. The standard treatment for stage I seminoma is either surveillance, radiotherapy, or chemotherapy.
2) For stage IIA/B seminoma, treatment options are radiotherapy or 3-4 cycles of chemotherapy. Radiotherapy provides better outcomes for stage IIA.
3) Advanced or metastatic seminoma (stage IIC/III) is treated with chemotherapy, with 5-year survival rates of 95% for good prognosis patients and 87% for intermediate prognosis.
More Related Content
What's hot
Pancreatic Trauma
The document discusses pancreatic trauma, including relevant anatomy, epidemiology, etiology, presentation, workup, staging, and treatment. Some key points:
- The pancreas is protected by surrounding structures but can be injured by penetrating trauma or direct blunt force.
- Injury is staged based on severity from grade I (minor) to grade V (massive disruption). Treatment depends on grade and location of injury.
- Workup may include labs, CT, MRCP, ERCP. Surgical treatment ranges from observation for minor injuries to distal pancreatectomy or pancreaticoduodenectomy for more severe injuries.
- Complications include pancreatic fistula, abscess, and pseudocyst.
Colonic polyposis syndromes
Colonic polyposis refers to numerous polyps throughout the GI tract that are often precancerous. The most common type is familial adenomatous polyposis (FAP), an autosomal dominant condition caused by a mutation in the APC gene. People with FAP develop hundreds to thousands of colon polyps by their mid-30s, and colon cancer is inevitable without surgery to remove the colon. They are also at risk of polyps in the stomach and duodenum that can become cancerous. Treatment involves prophylactic colectomy, surveillance of the upper GI tract, and managing extracolonic manifestations such as osteomas and desmoid tumors.
Biliary stricture ppt
Biliary stricture is an abnormal narrowing of the bile duct. The most common cause is injury during cholecystectomy, accounting for 80% of non-malignant strictures. Bile duct injury can cause inflammation, fibrosis, scarring, and cirrhosis. Surgical treatment depends on when the injury is recognized, with immediate repair during surgery or delayed repair weeks later being options. Roux-en-Y hepaticojejunostomy is a common repair method that involves a mucosa-to-mucosa anastomosis of the bile duct to the jejunum. Factors like multiple prior repairs, proximal strictures, and surgeon inexperience can lead to poor outcomes.
Stomach pathology lecture
The normal gastric mucosa contains mucus-secreting cells in the cardia, acid-producing and pepsin-producing cells in the fundus and body, and hormone-producing cells in the pylorus. The stomach functions to mix and start digestion of food, activate enzymes, destroy bacteria, and absorb nutrients, alcohol, water, and vitamins. Common pathologies of the stomach include peptic ulcers, gastritis, tumors, and congenital anomalies like pyloric stenosis. Chronic gastritis is often caused by H. pylori infection and can lead to atrophy, intestinal metaplasia, and increased cancer risk over time if not treated.
Common bile duct stone
This case presentation describes a 34-year-old female patient who presented with right upper quadrant pain. She had a history of epigastric pain radiating to the back for 6 days along with jaundice. Imaging showed choledocholithiasis and cholecystolithiasis. She underwent open cholecystectomy with intraoperative cholangiogram, common bile duct exploration, and T-tube placement. Her postoperative course was uncomplicated and she was discharged with a T-tube in place.
Cystic pancreatic lesions
This document provides guidelines for the diagnosis and management of cystic pancreatic lesions. It discusses various types of cystic masses that can occur in the pancreas such as pseudocysts, serous cystadenomas, mucinous cystic neoplasms, intraductal papillary mucinous neoplasms (IPMN), and solid pseudo-papillary tumors. For each type, it provides information on characteristics, malignant potential, imaging appearance, and treatment approach. Initial evaluation of pancreatic cysts should aim to exclude pseudocysts based on history of pancreatitis. Morphological evaluation and cyst fluid analysis via EUS and FNA are important diagnostic tools to characterize cyst type and guide management.
Diverticulosis and diverticular disease
This document discusses diverticular disease, specifically diverticulosis and acute diverticulitis. It covers the epidemiology, pathophysiology, clinical presentation, investigations including CT and barium enema, differential diagnosis, and Hinchey classification of diverticulitis severity. Diverticulosis is asymptomatic protrusions in the colon wall that become symptomatic as diverticulitis in 20% of cases from obstruction, inflammation, or perforation. Risk factors include low fiber diet and increased age. CT is the best imaging method to diagnose and stage diverticulitis.
Acute Variceal Hemorrhage
This document provides definitions and background information about acute variceal hemorrhage. It defines acute variceal bleeding as hematemesis or melena within the last 48 hours in a known or suspected case of portal hypertension. Varices are the accepted source of bleeding if blood is seen arising from or clotted on top of an esophageal varix. Failure to control the bleeding is defined as rebleeding within 48 hours of treatment. The document discusses the anatomy of varices, risk factors for bleeding such as varix size, and complications associated with acute variceal hemorrhage such as high rebleeding and mortality rates.
Diagnosis and Treatment of Ascites
This document provides guidelines for the diagnosis and treatment of ascites. It defines ascites as fluid collection in the abdominal cavity, with cirrhosis being the most common cause, accounting for 80% of cases. The development of ascites in cirrhosis is associated with poor prognosis and impaired quality of life. Diagnostic evaluation of ascites involves abdominal ultrasound and diagnostic paracentesis of ascitic fluid. Treatment involves dietary salt restriction, diuretics such as spironolactone and furosemide, and therapeutic paracentesis for large volume ascites. Albumin administration is recommended with large volume paracentesis to prevent circulatory dysfunction. Refractory ascites that does not respond to medical therapy may require interventions
Gastric cancer management
This document discusses treatment options for gastric cancer, including surgery, chemotherapy, and radiation therapy. It covers various lymph node dissection classifications (D0-D2) and their roles in different stages of disease. Adjuvant therapies like chemotherapy and chemoradiation are recommended after surgery to improve survival outcomes. Perioperative and postoperative chemotherapy are supported by clinical trials to be beneficial in resectable gastric cancer.
Cholangiocarcinoma
- Cholangiocarcinoma is a rare cancer that affects the bile ducts. It can originate in the intrahepatic, perihilar, or distal bile ducts.
- Risk factors include primary sclerosing cholangitis, parasitic infections, hepatolithiasis, and viral infections like HCV and HBV.
- Diagnosis involves blood tests, imaging like MRI/MRCP and ERCP, and biopsy. Surgery is the main treatment for resectable tumors while chemotherapy may be given for unresectable cases. The prognosis is poor even after resection due to high recurrence rates.
Esophageal varices
esophageal varices are the second most common cause of upper GI bleed after PUD.These are actually the dilated veins which occur secondary to increase in the pressure in the portal circulation called as Portal Hypertension..
Hepatocellular carcinoma
This document discusses hepatocellular carcinoma (HCC), the most common type of primary liver cancer. It covers the epidemiology, risk factors, pathogenesis, clinical presentation, diagnosis, prognostic factors, and treatment options for HCC. The highest rates are seen in regions where hepatitis B is endemic, and major risk factors include chronic hepatitis B and C infections, cirrhosis, and aflatoxin exposure. Diagnosis involves imaging tests like ultrasound, CT, and MRI along with blood tests. Treatment depends on tumor size and liver function, and may include resection, transplantation, ablation, embolization, or chemotherapy.
Anal cancer ppt
The anal canal is approximately 4 cm in length extending from the anorectal junction to the anal verge. Anal cancers are rare and mostly squamous cell carcinomas arising from the anal transitional zone. Risk factors include HPV infection and immunosuppression. Combined chemoradiotherapy is the standard first-line treatment and results in high response rates and organ preservation compared to radiation alone. Salvage surgery may be considered for select cases after failed nonsurgical treatment or as primary treatment for those who cannot tolerate chemoradiotherapy. Prognosis depends on tumor stage, with 5-year survival rates ranging from 45-86% depending on depth of invasion and nodal involvement.
CBD stones/ Choledocholithiais / Biliary stones
The document discusses the management of choledocholithiasis or common bile duct stones. It covers the clinical features, investigations like ultrasound, CT, ERCP and MRCP. It discusses the diagnostic approach and various management options including endoscopic procedures like ERCP with sphincterotomy and plastic stent placement. It also discusses open CBD exploration techniques like choledochotomy and T-tube placement. Laparoscopic CBD exploration is mentioned as a minimally invasive method. Guidelines recommend ERCP as first-line treatment for CBD stones with timing based on severity of cholangitis. Sphincterotomy with balloon dilation and cholangioscopy-assisted lithotripsy are suggested for difficult stones.
Evidence Based Treatment of Acute Pancreatitis 2013
The document summarizes guidelines for the diagnosis and management of acute pancreatitis. It addresses criteria for diagnosis, risk stratification based on severity (mild, moderately severe, severe), initial assessment including fluid resuscitation goals, nutritional support, and recommendations for enteral versus parenteral nutrition based on severity. The guidelines emphasize early aggressive fluid resuscitation, monitoring for organ failure, and initiating enteral nutrition in severe cases to prevent infectious complications while avoiding parenteral nutrition.
Gallstones
Powerpoint Presentation briefly describing Gallstones and its etiology, risk factors, as well as complications.
Benign tumor of liver : Hepatocellular origin
Benign tumor of liver : Hepatocellular origin that includes Adenoma, dysplastic nodule,focal nodular hyperplasia and others
Renal cell carcinoma
A 46-year-old female presented with left lumbar pain radiating to the left leg for 1 month. Imaging revealed a large renal cell carcinoma arising from the left kidney. She underwent renal tumor embolization followed by a left radical nephrectomy. Her postoperative course was unremarkable and her biopsy confirmed chromophobe renal cell carcinoma. She was discharged on medications and advised follow up with the urologist and biopsy results. Renal cell carcinoma accounts for 3% of adult cancers and is more common in males. Presentation may include flank pain, mass, or hematuria. Treatment involves surgery, radiation, targeted drug therapies, and immunotherapy depending on stage. Prognosis depends on stage, with earlier stages
Cholangiocarcinoma ppt
This document provides information on cholangiocarcinoma (CC), a type of cancer that forms in the bile ducts. It discusses the anatomy and classification of CC, as well as risk factors like primary sclerosing cholangitis. Symptoms of CC include jaundice, abdominal pain, and weight loss. Diagnosis involves blood tests, imaging like MRI/MRCP, and tissue sampling. CC is staged according to tumor involvement. Treatment may include surgery if possible, with palliative options for unresectable disease like stenting. Prognosis depends on stage, with early stage having higher survival rates.
What's hot (20)
Evidence Based Treatment of Acute Pancreatitis 2013
Evidence Based Treatment of Acute Pancreatitis 2013
Similar to GIST
Pancreratic Endocrne Tumors.pptx
1. Pancreatic endocrine tumors (PETs) are rare neuroendocrine tumors that arise from pancreatic islet cells. They include functional tumors like insulinomas and gastrinomas, as well as non-functional PETs.
2. Insulinomas are the most common functional PET and cause hypoglycemia. Diagnosis involves demonstrating inappropriate insulin levels during hypoglycemia. Surgical resection is usually curative.
3. Gastrinomas cause Zollinger-Ellison syndrome with severe peptic ulcer disease. They are often malignant and surgical resection offers the best chance of cure if localized.
MANAGEMENT 0F SEMINOMA CURRENT STATUS AND FUTURE DIRECTIONS.pdf
1) Seminoma is the most common germ cell tumor in young males. The standard treatment for stage I seminoma is either surveillance, radiotherapy, or chemotherapy.
2) For stage IIA/B seminoma, treatment options are radiotherapy or 3-4 cycles of chemotherapy. Radiotherapy provides better outcomes for stage IIA.
3) Advanced or metastatic seminoma (stage IIC/III) is treated with chemotherapy, with 5-year survival rates of 95% for good prognosis patients and 87% for intermediate prognosis.
Neuroendocrine tumors (Gastroduodenal)
This document discusses neuroendocrine tumors (NETs) of the gastroenteropancreatic system, focusing on gastric and duodenal NETs. It covers the molecular pathogenesis, classification, biomarkers, imaging techniques, and treatment approaches for gastroenteropancreatic NETs. Key points include that gastric NETs are classified into three types, duodenal NETs can originate from gastrinomas or somatostatinomas, and biomarkers like chromogranin A, 5-HIAA, and pancreastatin can help in diagnosis along with localization techniques like endoscopic ultrasound, CT, MRI, and somatostatin receptor imaging.
Pancreatic neuroendocrine tumors
1. Neuroendocrine tumors (NETs) arise from neuroendocrine cells throughout the body and share features like secretory granules and hormone production. Pancreatic NETs (PNETs) comprise 1-2% of pancreatic tumors.
2. PNETs can be functional, producing symptoms from hormone hypersecretion, or nonfunctional. Major functional types are insulinomas, gastrinomas, VIPomas, and glucagonomas. Nonfunctional PNETs are usually larger and have worse prognosis than functional tumors.
3. Treatment involves surgical resection for localized disease. For advanced or metastatic disease, options include somatostatin analogs, hepatic artery embolization, targeted drugs, and
Urological malignancies for MBBS students
This document discusses various urological malignancies including:
1. Renal masses like renal cell carcinoma which can be clear cell, chromophobic, or chromophilic subtypes. Symptoms include flank pain and masses. Treatment involves surgery or immunotherapy.
2. Bladder cancer which is usually transitional cell carcinoma caused by smoking. Symptoms include hematuria and can be staged from superficial to muscle invasive to metastatic. Treatment depends on stage.
3. Prostate cancer which spreads via bone and lymph nodes and is staged using TNM. It is assessed using PSA and treated with surgery, radiation or hormone therapy depending on risk level.
Ca esophagus 12th
This document provides information on carcinoma of the esophagus, including:
- Esophageal cancer is the 8th most common cancer worldwide, with high incidence rates in parts of Africa and Asia. Squamous cell carcinoma and adenocarcinoma account for most cases.
- The esophagus has three layers - mucosa, submucosa, and muscularis propria. It lacks a serosa, allowing early extraesophageal spread.
- Staging uses AJCC TNM and other systems to assess tumor size, lymph node involvement, and metastasis.
- Risk factors include smoking, alcohol, hot foods/liquids, micronutrient deficiencies, GERD, and Barrett's
Gastrointestinal stromal tumor (GIST) dr ridu kumar sharma
GISTs are the most common mesenchymal tumors of the GI tract. They are driven by mutations in c-Kit and PDGFR genes. Surgery is the main treatment for localized disease, while imatinib is effective systemic therapy for advanced or metastatic GISTs. Imatinib targets the c-Kit mutation to inhibit tumor growth with acceptable toxicity. Tumor size and mitotic index are prognostic factors used for risk stratification. Ongoing research is exploring additional targeted therapies to treat GISTs.
Pancreatic neuroendocrine tumors (pnets)
Pancreatic neuroendocrine tumors (PNETs) are rare tumors that account for 2-3% of pancreatic tumors. They are often slow growing and have a better prognosis than pancreatic ductal adenocarcinoma. PNETs express neuroendocrine markers and do not arise from islet cells, but rather from ductal stem cells. They can be functional and secrete hormones, or non-functional. Imaging plays an important role in diagnosis, staging, and monitoring treatment response according to RECIST criteria. The 7th AJCC edition incorporates PNET staging with exocrine pancreatic tumors.
Testicular tumour/ case history
1. Testicular neoplasm is a rare malignancy that affects men aged 20-40 years old. It presents most commonly as a painless testicular mass.
2. Diagnostic workup includes physical exam, tumor markers, imaging, and biopsy. Seminomas and nonseminomas are the two main types and have different characteristics and treatment approaches.
3. Treatment depends on stage but may include surgery, chemotherapy, and radiation. The prognosis is generally good even for advanced or relapsed disease.
Esopageal cancer ,
This document provides information about esophageal cancer, including:
- Key symptoms include dysphagia and weight loss. Squamous cell carcinoma and adenocarcinoma are the main types.
- Risk factors include smoking, alcohol, obesity, and Barrett's esophagus. Cancer spreads locally through direct invasion and lymphatically.
- Staging involves endoscopy, CT, PET, and EUS. Treatment depends on staging and includes surgery, chemotherapy, radiation, or palliative care. Prognosis depends on stage, with a 5-year survival rate of 19% on average.
Neuroendocrine tumors of pancreas
Neuroendocrine tumors of the pancreas (PNETs) are a diverse group of neoplasms that can be functional or non-functional. Functional PNETs secrete hormones that cause distinct syndromes, while non-functional PNETs do not secrete hormones or their secretion does not cause symptoms. The most common functional PNETs are insulinomas, gastrinomas, vipomas, and glucagonomas. Treatment involves surgical resection with the goal of cure for localized disease. For advanced or metastatic disease, palliative treatments are used to control hormone secretion and tumor growth.
Colorectal Cancer
This document discusses colorectal cancer. Some key points:
- Colorectal cancer is the second most common cause of cancer deaths in North America. It affects the colon and rectum.
- Risk factors include family history, age over 50, inflammatory bowel disease, poor diet, smoking, and diabetes. Genetic changes like mutations in APC and DNA repair genes contribute to colorectal cancer development.
- Screening tools include fecal occult blood tests, sigmoidoscopy, colonoscopy, and virtual colonoscopy. Screening guidelines vary but generally recommend annual fecal tests, sigmoidoscopy every 5 years, or colonoscopy every 10 years starting at age 50. Family history of colorectal cancer may
Urologic malignancy
UROLOGY RENAL CANCER PENIS TESTICULAR CANCER PENILE CANCER BLADDER CANCER KIDNEY CANCER PROSTATE CANCER
Ca rectum
This document discusses carcinoma of the rectum. It begins by explaining the anatomy of the rectum and its blood supply, lymphatic drainage and innervation. It then discusses the epidemiology, risk factors, staging systems including Dukes and TNM classification. Signs and symptoms, diagnostic workup including endoscopic, radiological and biopsy evaluation are explained. Principles of surgical treatment including resection margins are outlined. The goal of surgery is eradication of the primary tumor along with adjacent mesorectal tissue.
Mediastinal Mass dr dharma poonia
1) Mediastinal masses can occur in the three compartments of the mediastinum and are diverse in pathology. 2) CT is usually the initial imaging modality of choice to determine the location and characteristics of the mass. 3) Tissue biopsy is often required before treatment planning to determine the specific diagnosis, as the approach depends on factors such as location, imaging features, and patient age.
Pancreatic Cancer
This document provides information on pancreatic adenocarcinoma, including its anatomy, physiology, clinical presentation, investigations, staging, treatment and prognosis. It discusses the exocrine and endocrine functions of the pancreas. It also covers cystic lesions of the pancreas and pancreatic endocrine tumours. The staging and survival rates for pancreatic cancer are presented. Complications of pancreatic surgery and mortality rates at high volume centers are summarized.
Hepatocellular carcinoma
Hepatocellular carcinoma is the most common primary liver tumor. Risk factors include hepatitis B and C infections, alcohol use, and exposure to aflatoxins. It typically presents with nonspecific symptoms in patients with underlying liver disease or cirrhosis. Diagnosis involves blood tests like alpha-fetoprotein along with imaging modalities. Treatment options depend on tumor stage and liver function, and may include surgical resection, liver transplantation, ablation, or chemoembolization. Prevention focuses on hepatitis B vaccination and screening high-risk groups to detect cancer early.
CA Pancreas- Niazi.pptx
Pancreatic carcinoma arises from either the exocrine or endocrine tissues of the pancreas. It most commonly originates in the pancreatic ductal cells of the head or body of the pancreas. Risk factors include increasing age, male gender, smoking, family history, and genetic conditions. Symptoms depend on the location of the tumor but commonly include jaundice, abdominal or back pain, weight loss, and new-onset diabetes. Diagnosis involves blood tests, imaging like CT, MRI, ERCP, and biopsy. Staging uses the TNM system to describe tumor size and spread. Prognosis is generally poor due to late diagnosis but depends on tumor characteristics and treatment.
Soft tissue sarcomas
This document summarizes soft tissue sarcomas (STS), a rare type of cancer. It discusses that STS can occur anywhere in the body and there are over 100 subtypes. Surgery is the main treatment but chemotherapy and radiation therapy may also be used. Prognosis depends on factors like tumor size, grade, and whether it has metastasized. Recurrence is common and occurs in up to 50% of cases. Specific types discussed include gastrointestinal stromal tumor (GIST) and retroperitoneal sarcomas, which have poorer outcomes compared to extremity STS. Liposarcoma and leiomyosarcoma are two of the most common STS subtypes.
Differentiated thyroid carcinoma
Differentiated thyroid cancer includes papillary, follicular, and Hurthle cell carcinomas which arise from thyroid follicular cells. Papillary thyroid carcinoma is the most common type, accounting for 80-85% of cases. It typically presents as a slow-growing solitary thyroid nodule and has an excellent prognosis with a 95% 10-year survival rate. Surgical treatment may include total thyroidectomy followed by radioactive iodine (RAI) therapy in high-risk cases. Long-term monitoring involves measuring serum thyroglobulin and ultrasound imaging of the neck. Localized recurrence is typically treated with surgery while metastatic disease is managed with additional RAI if radioiodine avid or other modalities if not
Similar to GIST (20)
MANAGEMENT 0F SEMINOMA CURRENT STATUS AND FUTURE DIRECTIONS.pdf
MANAGEMENT 0F SEMINOMA CURRENT STATUS AND FUTURE DIRECTIONS.pdf
Gastrointestinal stromal tumor (GIST) dr ridu kumar sharma
Gastrointestinal stromal tumor (GIST) dr ridu kumar sharma
Recently uploaded
Journal Article Review on Rasamanikya
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
It includes regulation of combination products and medical devices. FDA and industry liaisons.
Top Effective Soaps for Fungal Skin Infections in India
Swisschem Dermacare has mentioned the List of The Best Antifungal Soap In India 2022. All of these soaps are trusted by various Dermatology Experts.
The Best Ayurvedic Antacid Tablets in India
Treat the symptoms of indigestion, heartburn and stomach reflux with the 10 Best Ayurvedic Antacid Tablets in India.
Top 10 Best Ayurvedic Kidney Stone Syrups in India
we have mentioned the best 10 ayurvedic Kidney Stone Syrups. You can check all these products and choose the best one for yourself.
Efficacy of Avartana Sneha in Ayurveda
Avartana Sneha is a unique method of Preparation of Sneha Kalpana in Ayurveda, mainly it is indicated for the Vataja rogas.
The Electrocardiogram - Physiologic Principles
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Top-Vitamin-Supplement-Brands-in-India List
Swisschem Dermacare provides the Top 10 Vitamin Supplement Brands in India. To know more about us give us call at our official number
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.Osteoporosis - Definition , Evaluation and Management .pdf
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Recently uploaded (20)
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
Top Effective Soaps for Fungal Skin Infections in India
Top Effective Soaps for Fungal Skin Infections in India
Top 10 Best Ayurvedic Kidney Stone Syrups in India
Top 10 Best Ayurvedic Kidney Stone Syrups in India
Muscles of Mastication by Dr. Rabia Inam Gandapore.pptx
Muscles of Mastication by Dr. Rabia Inam Gandapore.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
Tests for analysis of different pharmaceutical.pptx
Tests for analysis of different pharmaceutical.pptx
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...
Osteoporosis - Definition , Evaluation and Management .pdf
Osteoporosis - Definition , Evaluation and Management .pdf
GIST
- 2. • Arise from any part of GI tract • Mesenchymal origin • Common site – Stomach (60%), jejunum & ileum (30%), duodenum (5%), colorectum (<5%), esophagus (<1%) • Incidence – Unclear • small tumors – maybe common but unnoticed • Clinically detectable – 1-3% of all GI neoplasia • Equally observed in males & females
- 3. • Mutations in KIT proto-oncogene (80%) • Mutations in PDGFRA (5% – 7%) • Other – SDHB deficient, BRAF mutation Exon 11 – (60%) Exon 9 – (10%) Exon 13 – (1%) Exon 17 – (<1%) Exon 18 Exon 12 Exon 14 Poor response to imatinib Highly responsive to imatinib
- 4. • Interstitial cells of Cajal – Pacemaker cells b/w smooth muscle cells & intramural neurons • Express KIT receptor oncogene Function of ICC • Generates contraction in GIT • Initiation & propagation of slow wave activity in GI muscles • Mediates motor input from CNS associated w/ digestion & peristalsis
- 5. GROSS • Well circumscribed, non- encapsulated • C/s – homogenous often lobulated; vary from tan to red to brown • Large tumors – areas of cystic degeneration, hemorrhage & necrosis
- 6. MICROSCOPY • Morphologically • Spindle (70%) • Epithelioid (20%) • Mixed (10%) • Pleomorphic (rare) • Arrangement • Fascicles or bundles • Nests • Diffuse Immunohistochemistry 95% are immunoreactive for CD117 & DOG1
- 7. • GI bleeding (most common) • Bloating • Early Satiety • Abdominal pain • Palpable mass • Obstruction Mucosa overlying the tumor ulcerates & bleeds Most discovered incidentally- Other surgery or endoscopy
- 8. Primary Tumors (T) TX Primary tumor can not be assessed TO No evidence of primary tumor T1 Tumor <2 cm, localized T2 Tumor 2-5 cm T3 Tumor 5-10 cm T4 Tumor >10 cm in greatest dimension Regional Lymph Nodes (N) N0 No regional lymph node metastasis N1 Regional lymph node metastasis Metastasis (M) M0 No distant metastasis M1 Distant metastasis (liver & peritoneum) Mitotic Index Low ≤5/50 HPF High >5/50 HPF
- 9. Group T N M Mitosis Stage 1 T1 or T2 N0 M0 Low Stage 2 T3 N0 M0 Low Stage 3A T1 N0 M0 High T4 N0 M0 Low Stage 3B T2 N0 M0 High T3 N0 M0 High T4 N0 M0 High Stage 4 Any T N1 M0 Any rate Any T Any N M1 Any rate Good prognosis Moderate prognosis Bad prognosis
- 10. • Von Recklinghausen’s disease (NF 1) • Carney’s triad (sporadic) • Carney-Stratakis syndrome • Extra intestinal paraganglioma • Pulmonary chondroma • Gastric epitheliod GIST No pulmonary chondroma Autosomal dominant w/ incomplete penetrance
- 11. ENDOSCOPY • Tumor of varying shape – dome shaped, fungating, annular w/ or w/o central ulcer • Biopsy taken ENDOSCOPIC ULTRASOUND (EUS) • Size >4cm • Irregular border • Echogenic foci >3mm • Cystic space >4mm Malignant behavior
- 12. CT SCAN • To assess resectability of large tumor, tumor size, adjacent organ involvement, metastatic spread to liver or peritoneum • Contrast – peripheral enhancement often w/ central areas of low attenuation (necrosis, hemorrhage) MRI • For assessment of hepatic mets FDG-PET + CT • Delineate lesions as small as <1cm
- 13. • Tumor >5 cm – metastatic potential, if easily resectable surgery • Smaller tumors – wedge excision • Larger tumors – may require gastrectomy or duodenectomy but lymphadenectomy not required • Tumor adherent to surrounding organs, tissues or to avoid intra-abdominal spillage – En-bloc resections
- 14. INDICATIONS • Metastatic disease • Resectable recurring IMATINIB MESYLATE– specific tyrosine kinase inhibitor (KIT & PDGFR); 1st line SUNITINIB MALEATE – multiple TK inhibitor; if resistant to imatinib (2nd line)
- 15. INDICATION • Non metastatic unresectable Treated w/ 3-6 months of imatinib (reduce size & vascularity of tumor)
- 16. GIST Resectable Resect Low risk of recurrence or metastasis <3cm & <5 mitoses/HPF Adjuvant Imatinib High risk of recurrence or metastasis >3cm & >5 mitoses/HPF Imatinib Unresectable Neoadjuvant Imatinib Reimage Resect Adjuvant Imatinib Unresectable Imatinib Metastatic Imatinib
- 17. • Bailey & Love’s Short Practice of Surgery – 27th edition • Sabiston Textbook of Surgery – 20th edition • Lewin, Weinstein & Riddell’s Gastrointestinal Pathology and its Clinical Implications – 2nd edition