Related Experiment Videos
Cancer in inflammatory bowel disease
1Mount Sinai School of Medicine, Department of Surgery, Box 1259, One East 100th Street, New York, NY 10029, USA.
The Mount Sinai Journal of Medicine, New York
|June 1, 2000
Summary
Cancer risk is elevated in inflammatory bowel disease (IBD) patients, with risks increasing with disease duration. Regular surveillance is crucial for ulcerative colitis (UC) and Crohn's disease (CD) patients due to increased cancer incidence.
Area of Science:
- Gastroenterology and Oncology
- Inflammatory Bowel Disease (IBD) Research
- Cancer Etiology and Risk Stratification
Background:
- Cancer in inflammatory bowel disease (IBD) has been documented since the mid-20th century, with early reports in ulcerative colitis (UC) and Crohn's disease (CD).
- IBD-associated cancers are preceded by dysplasia, and their relative risk escalates with the duration of the inflammatory bowel disease.
- Both UC and CD cancers manifest at earlier ages compared to de novo colorectal cancers.
Observation:
- CD-associated cancers typically occur more proximally than UC cancers, often at the site of overt disease.
- Absolute cumulative colon cancer frequencies are similar for UC (8%) and CD (7%) after 20 years.
- Increased colon cancer risk in CD persists even when the disease is confined to the small bowel.
Findings:
- Patients with IBD face elevated risks for extraintestinal and reticuloendothelial tumors, as well as specific cancers like ano-vulval and malignant melanoma in CD.
- Colitic colorectal cancers are frequently diffuse, extensive, multiple, and right-sided, presenting insidiously.
- Small bowel cancers in CD are predominantly adenocarcinomas, often presenting at a younger age and more distally, frequently leading to obstruction and delayed diagnosis.
Implications:
- The findings underscore the critical importance of regular surveillance protocols for all IBD patients to detect dysplasia and cancer early.
- Strictures in the colon of IBD patients confer a significantly higher risk for colon cancer, particularly in UC.
- Surgical interventions for IBD-related cancers range from segmental resections to palliative procedures, with prognosis comparable to de novo colon cancer post-operation.