Summary
Definition
History and exam
Key diagnostic factors
- massa
- hemorragia digestiva alta/baixa
- dor neuropática
- aumento da circunferência abdominal
- características de abdome agudo
Other diagnostic factors
- edema de membros unilateral
- perda de peso
- fadiga
- anorexia
- distensão abdominal, desconforto e dor
Risk factors
- síndromes geneticamente hereditárias
- radiação
- infecção por herpes-vírus humano tipo 8 (HHV-8)
- doenças congênitas
- sexo masculino
- linfedema
- história de exposição a carcinógenos químicos
Diagnostic investigations
1st investigations to order
- tomografia computadorizada (TC) do tumor primário
- ressonância nuclear magnética (RNM) do tumor primário
- TC do tórax
- biópsia para histologia
Investigations to consider
- tomografia computadorizada abdominal/pélvica
- ressonância nuclear magnética (RNM) da coluna vertebral total
- tomografia por emissão de pósitrons com fluordesoxiglucose/tomografia computadorizada (FDG-PET-CT)
- endoscopia
- hemograma completo
- exames de coagulação
- ureia
- creatinina
- testes da função hepática
- ecocardiograma ou angiografia sincronizada multinuclear (MUGA)
- técnicas auxiliares
Treatment algorithm
membro: estádio I
membro: estádio II, ressecável
membro: estádio III ou estádio IV selecionado (qualquer T, N1, M0), ressecável
membro: estádio III ou estádio IV selecionado (qualquer T, N1, M0), irressecável
membro: estádio IV, oligometástases com volume tumoral limitado ou linfonodos regionais
membro: estádio IV, metástases disseminadas
membro: recorrente
retroperitoneal/intra-abdominal: ressecável (primário ou recorrente)
retroperitoneal/intra-abdominal: irressecável
retroperitoneal/intra-abdominal: doença metastática, órgão único e volume tumoral limitado passível de terapia local
retroperitoneal/intra-abdominal: metástases disseminadas
tumor estromal gastrointestinal: ressecável com morbidade mínima
tumor estromal gastrointestinal: ressecável com morbidade significativa
tumor estromal gastrointestinal: irressecável
tumor estromal gastrointestinal: progressivo
tumor estromal gastrointestinal: recorrente ou metastático
Contributors
Authors
James S. Hu, MD, FACP
Associate Professor of Clinical Medicine
USC Norris Comprehensive Cancer Center
Los Angeles
CA
Disclosures
JSH declares that he has no competing interests.
Sant P. Chawla, MD, FRACP
Director
Sarcoma Oncology Center
Santa Monica
CA
Disclosures
SPC owns stock in AADi, Cellestia Biotech, CounterPoint, and Immix BioPharma, and has received grants, consulting fees, payments of honoraria, and payment from speakers bureau for Amgen, Roche, GSK, Threshold Pharmaceuticals, CytRx Corporation, Ignyta, Immune Design, TRACON Pharma, Karyopharm Therapeutics, Sarcoma Alliance for Research through Collaboration (SARC), Janssen, Advenchen Laboratories, Bayer, Inhibrx, NKMax, and Thyme.
Acknowledgements
Dr James S. Hu and Dr Sant P. Chawla would like to gratefully acknowledge Dr Swati Sikaria, Dr Jonathan C. Trent, Dr Saira Hassan, and Dr David Thomas, previous contributors to this topic.
Disclosures
SS, JCT and SH each declare that they have no competing interests. DT has received research support from Pfizer, Amgen, and Novartis.
Peer reviewers
Richard F. Riedel, MD
Professor of Medicine
Duke University
Durham
NC
Disclosures
RFR owns shares in Limbguard, has received institutional clinical research support from AADi, Adaptimmune, AROG, Ayala, BioAtla, Blueprint, Cogent, Daiichi-Sankyo, Deciphera, GlaxoSmithKline, InhibRx, NanoCarrier, Oncternal, PTC Therapeutics, SARC, SpringWorks, Tracon, and Trillium. He has been a consultant/advisor for AADi, Adaptimmune, Bayer, Blueprint, Boehringer Ingelheim, Daiichi-Sankyo, Deciphera, GlaxoSmithKline, NanoCarrier, SpringWorks and has received funding for travel from Deciphera.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
World Health Organization. WHO classification of tumours: soft tissue and bone tumours. 5th ed (Vol 3). Lyon, France: IARC Press; 2020.
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: soft tissue sarcoma [internet publication].Full text
Gronchi A, Miah AB, Dei Tos AP, et al. Soft tissue and visceral sarcomas: ESMO-EURACAN-GENTURIS Clinical practice guidelines for diagnosis, treatment and follow-up*. Ann Oncol. 2021 Nov;32(11):1348-65.Full text Abstract
Casali PG, Blay JY, Abecassis N, et al. Gastrointestinal stromal tumours: ESMO-EURACAN-GENTURIS Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2022 Jan;33(1):20-33. Abstract
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: gastrointestinal stromal tumors (GIST) [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Lipoma
- Úlcera gastrointestinal
- Linfoma
More DifferentialsGuidelines
- NCCN clinical practice guidelines in oncology: gastrointestinal stromal tumors (GIST)
- NCCN clinical practice guidelines in oncology: soft tissue sarcoma
More Guidelines
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