Upper Gastrointestinal Cancer: Delays in Diagnosis and Treatment Caused by Barriers to Healthcare in the Latino Community

Abstract

We report a case of an 81-year-old male immigrant from a Latin American developing country with a high burden of upper gastrointestinal neoplasms, who presented with a small bowel gastrointestinal stromal tumor (GIST) after 2 years of delay in the diagnosis due to multiple barriers to healthcare. The patient presented with a partial intestinal obstruction in an abdominal computed tomography (CT) scan suggestive of a GIST. Surgical resection was performed, and adjuvant therapy was initiated with imatinib (a tyrosine kinase inhibitor) after the diagnosis was confirmed. The patient had a successful outcome. Due to his migratory status, the patient planned to follow up with different health providers in two different countries, which constitutes a common challenge in the immigrant population.

Keywords: GIST; Health services accessibility; Healthcare disparities; Hispanic or Latino; Upper gastrointestinal tract.

Figure 1

Axial (a) and coronal (b) images of abdominal CT scan indicate a sizeable mass (arrow) adjacent to the proximal duodenum with central necrosis and gas-containing, measuring approximately 11 × 14 × 10 cm. Also, distention of the bowels right adjacent to the mass is noticeable without proximal distension. CT: computed tomography.

Figure 2

(a) In H&E stain, sections from the lesion showing the tumor spindle cell morphology and occasional mitoses. Immunohistochemical stains were performed, showing the tumor cells are negative for desmin (b), while strongly positive for c-kit/CD117 (c) and DOG1 (d). H&E: hematoxylin and eosin; DOG1: Discovered on GIST 1.

Figure 3

Barriers to access to health care encountered by the Latino population in their countries of origin and moving to the USA, including barriers to visit the emergency department, during hospitalization for treatment, and outpatient specialty clinic follow-up.