In recent years, our understanding of the biology and treatment of GIST has accelerated exponentially, presenting special challenges to clinicians across many disciplines.¹ Evolving therapy has transformed the landscape of GIST treatment, and has highlighted important issues ranging from histologic and molecular diagnosis to evolving criteria for risk stratification, and advanced imaging techniques to evaluate response to therapy.² An integrated multidisciplinary approach that draws upon the expertise of many different types of physicians is essential for ensuring that GIST patients get optimal treatment and professional support (Table).^1,3

The Multidisciplinary Approach: Partnering At All Stages for Patient Benefits^3-6

Presentation

Diagnosis

Resection

Risk
Stratification

Response
Evaluation

Primary care physician

Gastroenterologist

Radiologist

Surgeon

Pathologist

Medical
oncologist

The clinical presentation of GIST often depends on the tumor size and site.⁷ GISTs may not induce symptoms and are sometimes incidentally discovered during radiologic imaging for an unrelated condition or as a secondary finding in a surgical resection.⁸ When symptoms do arise, they are frequently general symptoms caused by the presence of a mass rather than symptoms that are GIST-specific.⁷

The initial workup in patients with suspected GIST is generally performed by either a primary care physician (PCP) or a gastroenterologist (GE). GISTs are relatively uncommon sarcomas, and identifying them can be challenging and requires the collaboration of an experienced pathologist in conjunction with a team of experts, from radiology to medical oncology. Diagnosis often occurs after resection and pathologic examination. Pathologic review plays a central role in initiating treatment algorithms.

Determining KIT (CD117) receptor positivity on immunohistochemistry is vital to the diagnosis of GIST.⁷ Computed tomography (CT) scans and magnetic resonance imaging (MRI) are also frequently used in the diagnosis of GIST.⁷

The assessment of the complex issues in GIST–such as receptor status, risk of recurrence, and response evaluation–is clinically challenging, so collaboration between radiology, surgery, pathology, and medical oncology is crucial. Even in cases in which a GIST has been completely resected, collaboration with a medical oncologist is essential to determine risk of recurrence and ensure that patients who may benefit from adjuvant treatment are not overlooked.

The potential benefits of multidisciplinary management include reducing the risk of recurrent disease, optimizing timing of surgery and organ preservation, enhancing response to drug therapies, and prolonging patient survival.³