Colorectal cancer and dysplasia in inflammatory bowel disease

• Published in: World journal of gastroenterology : WJG Vol. 14; no. 17; pp. 2662 - 2669
• Main Authors: Zisman, Timothy L, Rubin, David T
• Format: Journal Article
• Language: English
• Published: United States Clinical Research Fellow in Gastro-enterology,the University of Chicago Medical Center,5841 S.Maryland Avenue MC 4076,Chicago 60637,United States%The University of Chicago Medical Center,5841 S.Maryland Ave.MC 4080,Chicago,IL 60637,United States 07.05.2008; The WJG Press and Baishideng
• Subjects: Colitis, Ulcerative - complications; Colitis, Ulcerative - epidemiology; Colitis, Ulcerative - pathology; Colitis, Ulcerative - therapy; Colorectal Neoplasms - epidemiology; Colorectal Neoplasms - etiology; Colorectal Neoplasms - pathology; Colorectal Neoplasms - prevention & control; Crohn Disease - complications; Crohn Disease - epidemiology; Crohn Disease - pathology; Crohn Disease - therapy; Diagnostic Imaging; Evidence-Based Medicine; Humans; Intestine, Large - pathology; Mass Screening - methods; Practice Guidelines as Topic; Precancerous Conditions - epidemiology; Precancerous Conditions - etiology; Precancerous Conditions - pathology; Precancerous Conditions - prevention & control; Risk Factors; Topic Highlight; Dysplasia; Crohn's Disease; Inflammatory Bowel Disease; Ulcerative Colitis; Chemoprevention; Cancer
• ISSN: 1007-9327
• DOI: 10.3748/wjg.14.2662

Both ulcerative colitis and Crohn's disease carry an increased risk of developing colorectal cancer. Established risk factors for cancer among patients with inflammatory bowel disease (IBD) include the younger age at diagnosis, greater extent and duration of disease, increased severity of inflammation, family history of colorectal cancer and coexisting primary sclerosing cholangitis. Recent evidence suggests that current medical therapies and surgical techniques for inflammatory bowel disease may be reducing the incidence of this complication. Nonetheless heightened vigilance and a careful, comprehensive approach to prevent or minimize the complications of invasive cancer are warranted in this unique cohort of patients. Current guidelines for the prevention and early detection of cancer in this high risk population are grounded in the concept of an inflammation-dysplasia-carcinoma sequence. A thorough understanding of the definition and natural history of dysplasia in IBD, as well as the challenges associated with detection and interpretation of dysplasia are fundamental to developing an effective strategy for surveillance and prevention, and understanding the limitations of the current approach to prevention. This article reviews the current consensus guidelines for screening and surveillance of cancer in IBD, as well as presenting the evidence and rationale for chemoprevention of cancer and a discussion of emerging technologies for the detection of dysplasia.