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Extra-intestinal malignancies in inflammatory bowel disease: results of the 3rd ECCO Pathogenesis Scientific Workshop

Fernando Magro1, Laurent Peyrin-Biroulet2, Harry Sokol3

  • 1Gastroenterology Department, Centro Hospitalar S. João, Institute of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal; Institute for Molecular and Cell Biology, University of Porto, Porto, Portugal.

Journal of Crohn'S & Colitis
|June 1, 2013
PubMed

The incidence of lymphoproliferative disorders (LD) is increasing in developed countries. Patients with inflammatory bowel disease (IBD) exposed to thiopurines are at additional risk of three specific forms of LD: Epstein-Barr-Virus-related post-transplant like LD, hepato-splenic T-cell lymphoma and post-mononucleosis lymphoproliferation. The risk of the two latter forms of LD can be reduced when considering specific immunosuppressive strategies in young males. It is still unclear whether the risk of uterine cervix abnormalities is increased in IBD women, irrespective of the use of immunosuppressants. Given the excess risk demonstrated in various other contexts of immunosuppression, it is currently recommended that all women with IBD, particularly those receiving immunosuppressants, strictly adhere to a screening program of cervical surveillance and undergo vaccination against HPV, when appropriate. Patients with IBD receiving immunosuppressants are at increased risk of skin cancers. The risk of non-melanoma skin cancer is notably increased in patients receiving thiopurines. Recent data suggest that the risk of melanoma is mildly increased in patients exposed to anti-TNF therapy. All IBD patients should adhere to a program of sun protection and dermatological surveillance, whose details should take into account the other non-IBD-related risk factors.

Keywords:
Anti-TNF therapyBCCCDCINCOCCervical intra-epithelial neoplasiaCombination oral contraceptiveCrohn's diseaseEBVEpstein–Barr VirusExtraintestinal cancersHLHHPVHSTCLHaemophagocytic lymphohystiocytosisHepatosplenic T-cell lymphomaHuman papilloma virusIBDImmunosuppressive therapyInflammatory bowel diseasesLDLymphomasOROdds ratioPaPPapanicolaouSCCSIRSkin cancersSquamous cell carcinomaStandardized incidence ratioThiopurinesUCUVUlcerative colitisUltravioletUterine cervix cancersX-linked lymphoproliferative syndromeXLP syndromebasal cell carcinomalymphoproliferative disorder

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