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Cancer in Crohn's disease
1Department of Medicine, Harvard Medical School, Boston, MA 02115, USA. sfriedman1@partners.org
Gastroenterology Clinics of North America
|September 6, 2006
Summary
Crohn's disease (CD) is linked to colorectal and small bowel adenocarcinoma (SBA), with screening recommended for long-standing colitis. Immunomodulators may increase lymphoma risk.
Area of Science:
- Gastroenterology
- Oncology
- Clinical Medicine
Background:
- Numerous studies suggest a link between Crohn's disease (CD) and various cancers.
- Evidence is strongest for colorectal adenocarcinoma, small bowel adenocarcinoma (SBA), and perianal fistulizing disease-associated cancers.
- Historical treatment limitations and surgical interventions in past studies may influence current understanding.
Purpose of the Study:
- To critically evaluate the evidence linking Crohn's disease to different types of cancer.
- To determine appropriate screening and surveillance strategies for patients with Crohn's disease.
- To assess the impact of evolving treatments on cancer risk in CD.
Main Methods:
- Review and analysis of existing case reports, case series, and population-based studies.
- Examination of surveillance data from patients with extensive, long-duration Crohn's colitis.
- Comparative analysis of cancer risk in Crohn's colitis versus ulcerative colitis (UC).
Main Results:
- Sufficient evidence supports a link between CD and colorectal adenocarcinoma, SBA, and perianal cancers.
- A surveillance study showed a 22% risk of neoplasia in long-standing Crohn's colitis.
- Cancer risk in Crohn's colitis is comparable to UC with similar disease extent and duration.
- Screening is advised for Crohn's colitis affecting at least one-third of the colon for over 8 years.
- Absolute risk for SBA is low, but screening is warranted due to associated morbidity and mortality.
- Risk for lymphoma and leukemia is low but may increase with immunomodulators and biologics.
- Evidence linking carcinoid tumors to CD is weak, requiring further population-based studies.
Conclusions:
- Patients with extensive, long-standing Crohn's colitis require surveillance similar to ulcerative colitis patients.
- Screening and surveillance for small bowel adenocarcinoma in CD patients with extensive disease are recommended.
- The use of immunomodulators and biologics may alter the landscape of cancer risk in Crohn's disease.
- Further research, particularly population-based studies, is needed to clarify certain cancer associations.
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