Inflammatory bowel disease and neoplasia in children

Advances in our understanding of the pathophysiology of ulcerative colitis and Crohn's disease have led to the widespread use of increasingly potent immunosuppressive therapies. This has greatly benefited the majority of patients with inflammatory bowel disease (IBD) and has resulted in improved overall clinical outcomes and quality of life. However, a growing body of data now indicates that long-term use of these agents may at the same time place patients at risk for a number of adverse effects, including colorectal and skin cancer, as well as lymphoma. Children and adolescents may be at particular cumulative risk for the development of these malignancies as a result of their young age at diagnosis, often increased disease extent and severity, and greater lifetime exposure to immunosuppressive agents. More recent epidemiologic studies are now identifying specific genetic and treatment-related factors that may place patients at increased risk for the development of IBD-related cancer. Improved understanding of these risk factors should contribute to a more rational approach to the pharmacologic management of children and young adults with IBD. Similarly, clinicians will be better able to counsel patients about the risks and benefits associated with specific therapies and develop improved monitoring guidelines to reduce the incidence of these rare but often severe oncologic complications.