Navigating Neoplasm Risk in Inflammatory Bowel Disease and Primary Sclerosing Cholangitis

Area of Science:

• Gastroenterology and Hepatology
• Oncology

Background:

• Patients with inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC) exhibit a markedly elevated risk for colorectal cancer (CRC) and cholangiocarcinoma (CCA).
• The precise molecular mechanisms driving this heightened oncogenic risk in PSC-IBD patients are not fully elucidated.
• This review synthesizes current knowledge on cancer development, diagnostics, and prevention in this specific patient cohort.

Purpose of the Study:

• To review and consolidate recent findings on cancer risk in patients with primary sclerosing cholangitis and inflammatory bowel disease (PSC-IBD).
• To focus on the molecular pathways, diagnostic innovations, and prevention strategies relevant to colorectal cancer (CRC) and cholangiocarcinoma (CCA) in this population.

Main Methods:

• A systematic literature search of PubMed was conducted up to March 2025.
• Studies focusing on oncogenic processes, molecular mechanisms, and advancements in diagnostic and preventive strategies for CRC and CCA in PSC-IBD patients were included.

Main Results:

• Current surveillance includes annual colonoscopy for CRC and imaging with CA 19-9 monitoring for CCA.
• Emerging research implicates molecular alterations, such as epigenetic modifications, in the tumorigenesis of PSC-IBD.
• Innovations in molecular diagnostics, imaging, and endoscopic techniques enhance the accuracy and efficiency of cancer detection.

Conclusions:

• Individuals with PSC-IBD face persistent high risks for CRC and CCA, underscoring the necessity of rigorous surveillance and proactive prevention.
• Advances in early detection and precision diagnostics present significant opportunities to mitigate the cancer burden in this vulnerable group.