[Verse 1]
Spindle cells beneath the mucosa, quiet and sly
CD117 positive, c-KIT lighting the sky
Interstitial cells of Cajal gone rogue in the wall
Stomach's the commonest site, but they crop up in all
EUS-FNA to sample, but handle with care
Biopsy's fraught with seeding risk, tread light if you dare
CT and MRI to map the territory wide
PET scan for metabolic read, nowhere left to hide
[Chorus]
G-I-S-T, know your mutation first
Wedge resection, R0 margin, no nodes in the hearse
Imatinib the frontline sword, adjuvant and neoadjuvant blades
SSG XVIII gives three years, resistance then escalates
G-I-S-T — stratify the risk
Size and mitotic index, malignant in the midst
Rupture is catastrophic, spillage seals the fate
Laparoscopic, site-specific, cytoreduction late
[Verse 2]
Risk stratification — count the mitoses per field
Size below two centimetres, low-risk widely healed
But gastric versus duodenal versus rectal location
Shifts the tier dramatically, demand recalibration
Contiguous resection, wedge without lymphadenectomy
GIST rarely seeds the nodes, that lymph dissection's empty
GEJ tumours need finesse — intragastric ports deployed
Lesser curve protects the vagus, function not destroyed
Duodenal GIST — pancreas-sparing if you can
Segmental or Whipple weighed against oncological plan
[Chorus]
G-I-S-T, know your mutation first
Wedge resection, R0 margin, no nodes in the hearse
Imatinib the frontline sword, adjuvant and neoadjuvant blades
SSG XVIII gives three years, resistance then escalates
G-I-S-T — stratify the risk
Size and mitotic index, malignant in the midst
Rupture is catastrophic, spillage seals the fate
Laparoscopic, site-specific, cytoreduction late
[Bridge]
Exon eleven mutation, imatinib sings clear
Exon nine demands four hundred milligrams a year — doubled dose
PDGFRA D842V — avapritinib's the ghost
Wild-type tumours harbour SDH deficiency
Paediatric GIST clusters in a different frequency
Resistance emerges — secondary mutations bloom
Sunitinib second line, regorafenib third in the room
Ripretinib for the fourth line, when options grow vermiculate
Creeping through resistant pathways, kinase loops accumulate
[Verse 3]
Metastatic disease, the liver bears the brunt
Peritoneum scattered next, cytoreduction the front
Imatinib controls the burden, surgery on response
Debulk when maximum benefit, calculate your nonce
Never rupture at retrieval, specimen bag the tool
Laparoscopic extraction guarded by that cardinal rule
Recurrence risk demands surveillance — CT every six months planned
Three years post-resection minimum, adjuvant close at hand
[Chorus]
G-I-S-T, know your mutation first
Wedge resection, R0 margin, no nodes in the hearse
Imatinib the frontline sword, adjuvant and neoadjuvant blades
SSG XVIII gives three years, resistance then escalates
G-I-S-T — stratify the risk
Size and mitotic index, malignant in the midst
Rupture is catastrophic, spillage seals the fate
Laparoscopic, site-specific, cytoreduction late