When you hear stomach cancer, you may assume that all tumours in the stomach behave the same way. However, it is not true. Gastrointestinal stromal tumours, or GISTs, are a rare and distinct type of tumour that arises in the digestive tract - most commonly in the stomach and small intestine - and they behave very differently from conventional gastric cancers.

Understanding this difference can be life-changing.

According to Dr. Asim Rizvi, Principal Director, Surgical Oncology & Robotic Surgery, GISTs originate from the interstitial cells of Cajal, which function as pacemaker cells responsible for regulating gastrointestinal motility. “Their distinct cellular origin differentiates them from conventional gastric cancers,” he said. The key symptoms of GISTs include abdominal pain, bleeding, fatigue, and weight loss. Treatment involves surgical resection and tyrosine kinase inhibitors like imatinib.

Since they arise from these deeper, muscle-layer cells, GISTs are classified as mesenchymal tumours, not epithelial cancers like most gastric malignancies. This cellular origin is the key reason why their biology and treatment are different.

One of the most important breakthroughs in understanding GISTs came from discovering their molecular drivers. Most GISTs are linked to mutations in the KIT or PDGFRA genes.

“These genetic features influence tumour behaviour and therapeutic response, making GISTs particularly responsive to targeted therapy rather than conventional chemotherapy or radiotherapy, which generally have limited clinical benefit in such cases,” said Dr Rizvi.

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Because these genetic alterations make GISTs particularly responsive to targeted therapy, drugs are designed to block the abnormal proteins produced by these mutations.

Dr. Rizvi said, unlike traditional chemotherapy or radiotherapy, which often show limited benefit in GIST, targeted oral medications can directly interfere with the tumour’s growth signals. This precision approach has significantly improved outcomes for many patients.

In early stages, GISTs may not cause noticeable symptoms, a few of these are discovered incidentally during scans

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