Gastro-Intestinal Cancer management

The treatment of Gastrointestinal stromal tumor is highly dependent on the size of the tumour. The other factors upon which the Surgical Oncologist in Bangalore depend is the area over which the tumour has spread so far and how fast the rate of growth is.

Localised and resectable tumours

In some cases, the size of tumours may appear in smaller than 2 centimetres diameter. The doctors prefer to watch those with care as these are not able to create any symptoms. The process of endoscopy may be attempted once or twice a year. If it is seen that the tumours are not growing in size, then the doctors suggest discontinuing the treatment.

The Surgical Oncologist in Bangalore opts for the surgical procedure for treating smaller tumours. But it depends on the probability of coming back of the tumour.

The surgeon suggests not going for surgery in the cases of Localised and resectable tumours. This is because such tumours might grow in size after surgery. If cancer does not start in the stomach or the cells show an affinity to quick division, then cancer might have a higher chance to relapse. When the doctor thinks that cancer has an intermediate or high risk of coming back based on these factors, adjuvant treatment is suggested along with targeted drug imatinib or Gleevac for at least one year after surgery. At least three years of imatinib is recommended for tumours that have the highest chances of coming back.

Localised and marginally resectable tumours

In certain cases, tumours are found to be larger or are placed in such a position of the body that makes the resection policy an impossible task. In such cases, the Surgical Oncologist in Bangalore has to depend on extensive surgical procedures. Again, these procedures may cause health issues afterward. For this reason, doctors hesitate to recommend surgical procedures.
A biopsy is done previously to ensure that the tumour is a GIST. After the performance of biopsy, treatment is started with the targeted drug imatinib for effective shrinkage of the tumour. The procedure is continued until the tumour stops shrinking.

After enough shrinkage of the tumour, surgery might be recommended provided the doctor thinks that the removal of the tumour can be done safely. The process of Imatinib will be continued after surgery to reduce the possibility of relapse.

When the tumour is not enough to shrink to facilitate the surgical process, imatinib could still be continued for as long as this might be though helpful. The doctor may be required to upgrade the dose when he/she feels the process does not yield the expected result. Use of another targeted drug sunitinib may be implemented when it is observed that the upgrading of imatinib produces severe side-effects. If the latter is not working even, the use of regorafenib is seen to help the ailing.

Tumours not removable or spread to distant sites

GISTS that cannot be removed with surgery or have spread are encountered with the following treatment options:

Why these are non-resectable

How far these have spread

The Surgical Oncologists in Bangalore do not go for the surgical option in the first instance. They recommend the performance of Biopsy to know that the tumour is a GIST.
After confirming that the tumour under consideration is a GIST, Imatinib is chosen as the first course of treatment. This is continued until the tumour does not grow. The doctor also sees that the patient can sustain the side effects of the drug. When the tumour shows an affinity for further growth, the doctor may require increasing the dose of imatinib. There may be cases where the tumour continues to show the affinity to grow or the side effects from imatinib become too severe. In such cases, the doctor prefers a switch to sunitinib. If the second one is no longer working, regorafenib may be placed to find out the appropriate solution.

If the tumor shrinks enough with targeted therapy, surgery may then be an option for some patients. This might be followed by more targeted therapy if it is still effective.

Surgical Oncologist in Bangalore

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