Name: Surgical Oncology for Gastrointestinal Stromal Tumors (GIST): Ask Dr. Waddah Al-Refaie
Uploaded: 2014-06-02T09:01:10.000Z
Duration: 13 min 10 s
Description: Thousands of YouTube videos with English-Chinese subtitles! Now you can learn to understand native speakers, expand your vocabulary, and improve your pronunciation...

I'm Dr. Waddah Al-Refaie, I serve as the chief of surgical oncology

at MedStar Georgetown University Hospital,

I also serve as the surgeon in chief for the Lombardi Comprehensive Cancer Center.

I have the high privilege of caring for patients with GI cancer,

soft tissue sarcoma, gastrointestinal stromal tumors

To be diagnosed with cancer is a devastating diagnosis, and it impacts

the way you think and it impacts your lifestyle

and all the future decisions that you have.

As a surgical oncologist, I see the glass half full.

There's a treatment option for nearly every individual.

So we're here to help our patients the best that we can

and offer those patients hope at their very vulnerable times of their life.

Surgical oncology is special to have evolved over the last 2-3 decades.

Surgeons spend 2-3 years at the major Comprehensive Cancer Center

learning tools and techniques, and I'm a member of a team

and feel intensely committed to this team approach

It's challenging, it keeps you thinking all the time

at how can we help our patients and offer them the best outcomes that we can.

The diagnosis itself can be at times challenging and require

Some of the diseases, you have 50 types of sarcoma different from each other.

So again, you'd like to be at a center where your pathologists, surgeons,

medical oncologists, radiologists are working together,

familiar with these diseases and be able to streamline

the treatment decision for complex diseases.

So this is an environment where we're stimulated and challenged constantly

to help our patients, and I thrive in these kinds of environments

where it's research driven based on the latest treatment options

to offer our patients here at MedStar Georgetown University Hospital.

What we offer at MedStar Georgetown University Hospital

is an array of highly specialized physicians in various aspect of

We have specialized surgeons with fellowship training in surgical oncology,

you have specialized medical oncologists, you have radiation therapists

who are very familiar with that various types of disease sites,

and we have a very robust partnership with the Lombardi Comprehensive Cancer Center,

one of the few cancer canters in the nation that has

a Comprehensive Cancer Center designation,

and it's the only one in the D.C metro area. So we feel that we offer our patients

cutting-edge, the latest in access to cancer clinical trials

that very few centers in the country are able to offer

these kinds of treatment options to our patients with cancer.

GIST or Gastrointestinal Stromal Tumors are a rare group of tumors

that occur in the gastrointestinal tract,

so if I may describe to you what is a gastrointestinal tract or a GI tract

it's the organs in the abdominal cavity that are starting from the esophagus,

going through the stomach, then the intestines, the colon

and then the rectum ending in the anus itself.

So GIST are a group of tumors that have a tendency to occur

in the intestine itself, hence the name GI stromal tumors.

They're not very common as I mentioned, there are about 5,000-6,000 cases.

They tend to occur more commonly in the stomach because the stomach itself

has a larger surface area in the abdominal cavity.

The cause of GIST is basically due to an activation of a protein

or a molecule in a protein called KIT, spelled KIT or c-KIT

are found inside the cells of the muscles of the intestines themselves.

And the cells are called "interstitial cells of Cajal"

or "the pacemaker of the intestines" that lead to trigger

the movement of the intestines. So what happens in patients with GIST,

the cells develop in an uncontrolled manner and then lead to the development

The spectrum of the diagnosis of GIST varies, so in many patients

they do not have a particular symptom so the diagnosis of GIST is found

incidentally during a CT scan done for a lung nodule or for another reason.

At times a gastroenterologist who's performing an endoscopy

for an unrelated symptom and then an abnormality on the stomach is found

or a surgeon is operating on a patient for another reason

and then a gastrointestinal stromal tumor is found.

At other times, if the tumor is large, patients do present with feeling full

in the intestines, they have a change in their appetite,

a palpable mass is felt in the abdomen as well.

Rarely patients may present with blockage of their intestines or bleeding.

So GIST can occur anywhere in the intestinal tract

but it's more commonly, in about 60% of patients it occurs in the stomach itself

and I want to emphasize, patients sometimes use the word "stomach"

as a reflection of the entire intestinal cavity

but "stomach" is an organ on its own that may develop tumors and cancer

including gastrointestinal stromal tumors.

So the treatment of GIST is based on the stage of the patients.

At times a patient presents with very very small GIST tumors

and the treatment at that time is based on the size,

the location and whether surgery can help those patients or not.

At other times they present with a resectable or removable mass itself in the intestines

and there we offer surgery with or without targeted therapy

At other times, a patient will present with an advanced GIS tumor

that involves many organs and believe that the treatment should involve

at the beginning a pill that's called imatinib therapy to shrink it

At other times a patient unfortunately will present with a Metastatic GIST

that has spread to other organs like the liver or the lining

of the intestine itself. So essentially, the treatment is based on

the presentation or the stage itself of the disease.

So here at MedStar Georgetown University Hospital,

at  Lombardi Comprehensive Cancer Center, we have a team approach

to patients with gastrointestinal tumors.

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Surgical Oncology for Gastrointestinal Stromal Tumors (GIST): Ask Dr. Waddah Al-Refaie

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