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Local treatment for gastrointestinal stromal tumors, leiomyomas, and leiomyosarcomas of the gastrointestinal tract

Authors
Jeffrey Morgan, MD
Chandrajit P Raut, MD, MSc, FACS
Section Editors
Kenneth K Tanabe, MD
Robert Maki, MD, PhD
Deputy Editor
Diane MF Savarese, MD

INTRODUCTION

Stromal or mesenchymal neoplasms affecting the gastrointestinal (GI) tract are divided into two groups. The most common are neoplasms that are collectively referred to as gastrointestinal stromal tumors (GISTs). They are most often located in the stomach and proximal small intestine, but can occur in any portion of the alimentary tract and occasionally in the omentum, mesentery, and peritoneum [1-5].

A far less common group of mesenchymal GI tract neoplasms is comprised of a spectrum of tumors that are identical to those that might arise in the soft tissues throughout the rest of the body. These include lipomas, liposarcomas, leiomyomas, leiomyosarcomas, desmoid tumors, schwannomas, and peripheral nerve sheath tumors [6].

Local treatment options for GIST, leiomyomas, and leiomyosarcomas of the GI tract will be discussed here. The epidemiology, classification, molecular pathogenesis, clinical presentation, and diagnostic workup of GISTs, leiomyomas, and leiomyosarcomas of the GI tract, and the use of tyrosine kinase inhibitors (TKIs), both in the adjuvant and neoadjuvant setting, and for patients with metastatic GIST, are discussed elsewhere. (See "Epidemiology, classification, clinical presentation, prognostic features, and diagnostic work-up of gastrointestinal mesenchymal neoplasms including GIST" and "Adjuvant and neoadjuvant imatinib for gastrointestinal stromal tumors" and "Tyrosine kinase inhibitor therapy for advanced gastrointestinal stromal tumors".)

GENERAL SURGICAL PRINCIPLES

The management of GISTs, leiomyomas, and leiomyosarcomas involving the GI tract depends upon the confidence in the preoperative diagnosis, tumor location and size, extent of spread, and clinical presentation (eg, whether there is evidence of tumor obstruction, perforation, or uncontrolled hemorrhage). (See "Epidemiology, classification, clinical presentation, prognostic features, and diagnostic work-up of gastrointestinal mesenchymal neoplasms including GIST", section on 'Clinical manifestations'.)

Some general surgical principles apply to these tumors regardless of location:

                            

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Literature review current through: Nov 2016. | This topic last updated: Mon Sep 19 00:00:00 GMT+00:00 2016.
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