GIST tumours
What are they?
Gastrointestinal Stromal Tumours (GISTs) are growths arising from the inner wall (connective tissue) of the gastrointestinal tract. The majority (70%) occur in the stomach with the remainder mostly found in either the small bowel or the oesophagus.
Are they a form of cancer?
Yes, as any abnormal multiplication of cells can be described as a cancer. However, they can vary enormously in their behaviour. The malignant potential of any GIST tumour is determined by the size of the tumour and the degree of activity within it (mitotic index). This gives a grading to the tumour, which helps predict its behaviour.
How are they found?
GIST tumours can cause pain, bleeding or can obstruct the bowel lumen. Many GIST tumours are discovered incidentally during examination of the stomach by endoscopy or on a CT scan.
How are they investigated?
Gastroscopy is used to confirm the presence of the tumour and to exclude other types of pathology. GISTs arise beneath the lining of the stomach in the bowel wall so are difficult to biopsy. Ultrasound during endoscopy can help direct sampling of the tumour through the bowel wall and can further characterize it.
The typical endoscopic and CT appearances of GISTs, means they are often diagnosed without a biopsy. Diagnosis may not be finally confirmed until it has been removed.
How should it be treated?
Keyhole surgery can be used to remove the tumour. The exact procedure will depend on its size and location. Usually, the majority of the stomach can be preserved and recovery is short. Tumours less than 3 cm are usually low risk so can be kept under observation if removal would be high risk.
How is the surgery performed?
Small cuts are made in the abdominal wall to allow passage of keyhole instruments. The stomach is partially mobilised and the tumour removed. One of the cuts may need to be enlarged for removal of the tumour.
More information on Laparoscopic Surgery
Are there any risks?
If the tumour is in a simple location the surgery is low risk. Larger tumours or tumours in a difficult location can be more complex and occasionally require a slightly larger open incision.
How long will it take to recover from the surgery?
Patients are fully mobile after surgery and should commence fluids immediately after surgery. Sometimes, a check contrast study is performed after the procedure before patients start a soft diet. Patients remain on a soft diet for 4 weeks to allow the postoperative swelling to settle.
Patients will often require one or two nights in hospital. This is mainly to build confidence eating and drinking after the surgery. The wound sites will have local anaesthetic injected into them at the time of surgery. This will wear off about 6 hours after the procedure. To stop the sites becoming sore you should take the regular painkillers as instructed. Shoulder tip pain is not uncommon and is due to gas underneath the diaphragm. This should not last longer than 24 hours. You will not be discharged until you are comfortable and eating and drinking. On discharge you should be independent and able to climb a flight of stairs.
Which medications will I require after surgery?
You will be discharged from hospital with a supply of simple painkillers with instructions on how to use them. Regular paracetamol is particularly effective and can be combined with an anti-inflammatory drug (ibuprofen) or a codeine based drug (dihydrocodeine). Anti-inflammatories are not suitable for all patients and should be taken with food. The codeine-based drugs can cause constipation and should be taken with plenty of fluids. Most patients do not require painkillers after 5 days.
When can I return to work?
Generally it is recommended to take two weeks off after surgery. Your ability to return to work will depend on your job and varies between individuals. Patients can often return to work a week after surgery if required. We would not recommend flying immediately after surgery. This should be discussed on a case-by-case basis with the consultant.
When can I drive?
Driving should be avoided in the first week after surgery. Once you can perform an emergency stop in a stationary vehicle and turn to view your blind spot then driving should be safe. It is preferable to contact your insurance company to check for any specific instructions they may have.
Who do I contact if there are concerns?
The group practice telephone is answered in working hours and messages can be left out of hours. Any concerns will be relayed directly to one of the consultant surgeons on receipt. The hospital ward also provides a 24/7 means of contact. They will contact the consultant about any concerns and are able to give advice if required.
