American Board of Internal Medicine (ABIM) Certification Practice Exam

How are localized gastrointestinal stromal tumors (GISTs) managed?

1. Chemotherapy and targeted therapy

2. Surgical resection

3. Observation and monitoring

4. Radiation therapy

The correct answer is: Surgical resection

Localized gastrointestinal stromal tumors (GISTs) are primarily managed through surgical resection. This approach is based on the fact that GISTs, which often arise in the stomach or small intestine, can typically be completely removed if they are localized. Complete surgical resection of the tumor, along with a margin of healthy tissue, is the most effective treatment to achieve long-term remission and prevent recurrence. Surgery is the first-line management for localized GISTs because it allows for direct removal of the tumor, whereas other modalities like chemotherapy or radiation therapy do not provide the same opportunity for curative treatment. While targeted therapies, such as imatinib (Gleevec), may be used in cases of unresectable tumors or in the adjuvant setting post-resection for high-risk patients, they are not the primary management for localized GISTs. Observation and monitoring can be appropriate in certain non-aggressive, small tumors, but the standard approach for localized tumors that are resectable remains surgical intervention. Radiation therapy is generally not effective for GISTs because these tumors are largely resistant to radiation and are better treated through surgical means. Thus, surgical resection stands out as the definitive management strategy for localized GISTs.