Intestinal cancer in inflammatory bowel disease: natural history and surveillance guidelines

Abstract

Inflammatory bowel diseases (IBD) are associated to an increased risk of colorectal cancer, which is primarily related to long-standing chronic inflammation. Recognized risk factors are the duration and extent of the disease, severe endoscopic and histological inflammation, primary sclerosing cholangitis, family history of colorectal cancer and in some studies young age at diagnosis. Recent population-based studies have shown that the risk is lower than previously described or even similar to that of the general population, and this could be justified by methodological aspects (hospital-based vs. population-based studies) or by a true decrease in the risk related to a better control of the disease, the use of drugs with chemoprotective effect or the spread of endoscopic surveillance in high-risk patients. Apart from colorectal cancer, patients with IBD are prone to other intestinal neoplasms (lymphoma, small bowel adenocarcinoma, pouch neoplasia and perianal neoplasia). In this article, the magnitude of the risk of intestinal cancer, the risk factors, the natural history of dysplasia and the recommendations of screening and surveillance in IBD are reviewed.

Keywords: Inflammatory bowel disease; colorectal cancer; dysplasia; risk factors; surveillance.

Figure 1

Management of flat dysplasia (*) Consider colectomy in high risk patients (PSC, family history of CRC, extensive colitis with severe endoscopic or histological inflammation); (**) High-risk patient: yearly colonoscopy; (**) Low or moderate risk patient: colonoscopy every 2-3 years [40,41] or every 3-5 years [42] PSC, primary sclerosing cholangitis; CRC, colorectal cancer

Figure 2

Management of raised dysplastic lesions