GIST Specialist for Palos Verdes Estates, CA
Most people diagnosed with a gastrointestinal stromal tumor were told something else first. Reflux, gastritis, irritable bowel, stress, age. The symptoms genuinely overlap, and the tumor hides from the obvious test. Joshua Ellenhorn, MD, FACS explains how that happens.
- Assessment where symptoms persisted despite treatment
- Clinical Professor of Surgery, Cedars-Sinai Medical Center
- Remote review of records before the drive off the hill
- Focus on the plan from here rather than the months behind
A Vague Tumor That Hides From the Obvious Test
Patients frequently arrive angry, and often at themselves. They spent a year on acid suppression, or were told they had irritable bowel, or were reassured that fatigue at their age was to be expected. Then a scan ordered for something unrelated found a tumor that had presumably been there throughout.
Two things make this pattern almost inevitable. The first is that the symptoms are genuinely indistinguishable from common benign conditions. Bloating, filling up quickly at meals, a dull ache that is hard to localise, tiredness. Those describe reflux, gastritis, irritable bowel and ordinary life. Treating the likely explanation first is not poor medicine, it is how medicine works.
The second is more specific to this tumor. GIST grows within the wall of the digestive tract rather than on its inner surface, so it pushes outward into the abdomen. An endoscope looking at the lining may see only a slight smooth bulge under entirely normal tissue, which is easy to read as a fold. Small bowel tumors are worse: they sit beyond the reach of both an upper endoscopy and a colonoscopy, so a patient can have two normal examinations and still have a tumor bleeding steadily.
Where the reasoning should shift is when symptoms persist despite treatment, or when there is unexplained iron deficiency anemia. That second finding, in a man or in a woman past menopause, has no benign explanation and should always lead to imaging of the digestive tract rather than an iron prescription.
What GIST Symptoms Get Attributed To
Every row here is a reasonable first assumption. The column on the right is what should prompt a rethink.
| Symptom | Usually attributed to | What should prompt further investigation |
|---|---|---|
| Early fullness, bloating | Reflux, gastritis, irritable bowel | Persisting despite treatment, or worsening rather than fluctuating |
| Dull ache or abdominal pressure | Indigestion, muscular strain, stress | A constant location rather than a moving one, or symptoms waking you at night |
| Fatigue and breathlessness | Age, overwork, deconditioning | A low blood count on testing, particularly with low iron |
| Iron deficiency anemia | Diet, in women menstruation | Any unexplained case in a man or a post-menopausal woman. This one should always be investigated |
| Dark stools | Iron tablets, diet | Recurrence after stopping iron, or associated light headedness |
| Nausea, occasional vomiting | Gastritis, gallbladder, medication | Vomiting with distension and nothing passing, which suggests obstruction |
| Normal endoscopy despite symptoms | Reassurance, functional diagnosis | Persisting symptoms with a normal scope is exactly when cross sectional imaging is indicated |
A contrast CT of the abdomen and pelvis is what sees a tumor growing outward from the wall, and what covers the small bowel. If symptoms persist after normal endoscopy, that is the reasonable next step.
Later Than It Should Have Been Is Not the Same as Too Late
The instinct after a delayed diagnosis is to assume the worst about what those months cost. It is worth knowing that with GIST the arithmetic is often gentler than with other cancers.
Many of these tumors grow slowly. Risk is graded by three things, size, site and how fast the cells are dividing, and a tumor with a low mitotic count may have been enlarging very gradually for years. A great many tumors found later than they should have been are still entirely resectable, still curable by a modest operation, and still carry a good outlook. The delay changed the probability rather than the outcome.
That is not a defence of every delay, and some genuinely do matter. But the useful focus now is forward. Has the mitotic index been counted? Has mutation testing been done? What risk category does that produce, and what operation follows from it? Those questions determine what happens next, and they are answerable this week regardless of what happened last year.
If the anger is sitting heavily, that is entirely understandable and worth talking to someone about. It should not be the reason a clear plan gets delayed further.
What Treatment Looks Like
Recordings of real GIST resections narrated by the surgeon who performed them. For most tumors found in the stomach, this is the scale of what is required.
Laparoscopic Resection of a Gastric GIST
A gastric GIST removed through small incisions with the capsule kept intact.
Gastric GIST Resection: A Simplified Approach
A refined approach that shortens operating time and recovery.
Robotic Resection of a Duodenal GIST
Duodenal GIST removed robotically with the pancreas and bile duct preserved.
Unexplained Anemia Always Warrants a Look
If you have family members who mention persistent unexplained tiredness and a low blood count, that finding has no benign explanation in a man or a post-menopausal woman. It is the most useful thing on this page.
Certifications and Appointments
Two American Board of Surgery certifications, a Cedars-Sinai teaching appointment, and membership of the societies that set the standards for this disease.
- American Board of Surgery, certified in General Surgery
- American Board of Surgery, certified in Colorectal Surgery
- California State Medical License
- Florida State Medical License
Joshua Ellenhorn, MD, FACS
Dr. Ellenhorn is a surgical oncologist and Clinical Professor of Surgery at Cedars-Sinai Medical Center, and a collaborative member of the Samuel Oschin Comprehensive Cancer Institute.
Patients arriving after a long diagnostic road often expect either to be told their previous doctors were incompetent or to have the delay smoothed over. Neither is much use. The honest position is usually that the earlier reasoning was defensible, that the tumor is genuinely good at hiding, and that the relevant work now is establishing the grading properly and deciding on an operation. Being straightforward about all three is more helpful than taking a side.
He is certified by the American Board of Surgery in General Surgery and in Colorectal Surgery, a Fellow of the American College of Surgeons, and a member of the Society of Surgical Oncology and the American Society of Clinical Oncology. He practises with the Surgery Group of Los Angeles.
What Patients Say
Reviews left by patients treated by Dr. Ellenhorn at the Surgery Group of Los Angeles.
★★★★★Very kind stuff, great service. Dr Joshua Ellenhorn is a very calm doctor who takes time with his patient.
Anita Lukacevic
★★★★★The staff at the Surgery Group of Los Angeles are wonderful. They are kind, very attentive, the office is clean and I did not have to wait long at all. I cannot say enough great things about Dr. Ellenhorn. He is an excellent surgeon who is highly skilled and very knowledgeable. I cannot thank him enough for all he has done for my family and I.
Erika Frank
From Palos Verdes Estates
Palos Verdes Drive to Hawthorne Boulevard north, then the 405 and the 10 east, north on La Cienega to 3rd Street. Forty five minutes to an hour depending on when you travel and how the 405 is running.
Given the distance, sending records ahead is usually the better first step. Imaging, endoscopy reports and pathology all travel electronically, and much of the assessment described on this page can be done before you commit to the journey.
The office is in the medical plaza attached to Cedars-Sinai Medical Center, so when you do come, imaging, pathology and consultation are in one building rather than requiring several trips off the hill.
8635 W 3rd St, Suite 880W
Los Angeles, CA 90048
Monday to Saturday, 11:00am to 8:00pm
Closed Sunday
Frequently Asked Questions
I was treated for reflux for a year before this was found. Was that negligent?
Why is GIST so often missed initially?
Has the delay harmed me?
What symptom should always have triggered investigation?
My endoscopy was reported as normal. How was the tumor missed?
What should I push for if symptoms persist?
Should I be angry with my doctor?
How far is your office from Palos Verdes Estates?
The Question Now Is the Grading, Not the Delay.
Mitotic index, mutation subtype, risk category, and the operation that follows. Those determine what happens next, whatever took you this long to get here.
