Cancer in Inflammatory Bowel Disease

Area of Science:

• Gastroenterology
• Oncology
• Internal Medicine

Background:

• Colorectal cancer (CRC) is a significant risk in patients with longstanding inflammatory bowel disease (IBD), including ulcerative colitis and Crohn's disease.
• While surgical therapy is effective for sporadic CRC and advanced IBD-related CRC, prophylactic colectomy is rarely recommended due to its impact and low absolute cancer risk.

Purpose of the Study:

• To review risk factors for CRC in IBD patients.
• To outline current strategies for CRC surveillance and management in IBD.
• To discuss the efficacy and limitations of current diagnostic and preventative measures.

Main Methods:

• Review of existing literature on CRC in IBD.
• Discussion of colonoscopic surveillance protocols, including biopsy strategies.
• Evaluation of surgical and chemopreventive options.

Main Results:

• Colonoscopic surveillance with systematic biopsies is the primary method for detecting dysplasia and identifying patients at high risk for CRC.
• Patients with dysplasia not amenable to simple excision require surgical referral.
• Current chemoprevention offers only modest benefits, and early detection methods for small intestine adenocarcinoma in Crohn's disease are lacking.

Conclusions:

• Colonoscopic surveillance is the best available method for reducing CRC mortality and morbidity in IBD patients, short of prophylactic colectomy.
• Surveillance protocols should be consistent for both ulcerative colitis and Crohn's disease.
• Further research is needed for improved diagnostic tests and chemopreventive strategies.