Use of biologics and chemotherapy in patients with inflammatory bowel diseases and cancer

Abstract

Patients with inflammatory bowel disease have an additional risk of developing cancer compared with the general population. This is due to local chronic inflammation that leads to the development of gastrointestinal cancers and the use of thiopurines, associated with a higher risk of lymphoproliferative disorders, skin cancers, or uterine cervical cancers. Similar to the general population, a previous history of cancer in inflammatory bowel disease patients increases the risk of developing a secondary cancer. Large studies have not shown an increased risk of cancer in patients treated with biologics. In this review we discuss the prevention and treatment of cancer in patients with inflammatory bowel disease.

Keywords: Crohn’s disease; anti-TNF; cancer; chemotherapy; ulcerative colitis.

Figure 1

Surveillance colonoscopies. (A) Surveillance colonoscopies for detecting dysplasia and preventing colorectal carcinoma. (B) Management of visible lesions at endoscopy. A visible lesion with dysplasia should be completely resected, independently of the grade of dysplasia or the localization relative to the inflamed mucosal areas. In the absence of dysplasia in the surrounding mucosa, the patient should follow the standard surveillance program. If endoscopic resection is not possible or if dysplasia is found in the surrounding flat mucosa, proctocolectomy should be recommended [27-29] CRC, colorectal cancer; IBD, inflammatory bowel disease; PSC, primary sclerosing cholangitis

Figure 2

Small bowel adenocarcinoma. A 45-year-old male, with a 26-year duration ileal Crohn’s disease presented with subobstructive symptoms. At magnetic resonance imaging (MRI), severe wall thickening and ulcerative stenosis was observed. The patient underwent a laparoscopic right hemicolectomy and the pathology study of the resected segment revealed an ileal adenocarcinoma. (A) T1-weighted MRI sequence in coronal plane after administration of gadolinium. Severe wall thickening (1 cm) and presence of inflamed lymph nodes, without inflammatory signs in the surrounding tissue can be observed. (B) T2-weighted MRI sequence in coronal plane. Additionally, a reduction of the lumen with ulcerative stenosis can be observed. (C) 25x magnification pathology study. Residual ileal mucosa can be observed in the left lower corner. The rest of the picture shows the transition to the ileal tumor, composed by very irregular and atypical glands in a fibrous stroma. (D) 400x magnification pathology study. Tumor glands can be observed in the resected ileum. They have a very irregular shape and are composed by atypical cells with big hypercromatic overlapping nucleus and necrotic material in the gland

Figure 3

Adenocarcinoma of intestinal origin adjacent to end-ileostomy. An 80-year-old male diagnosed with Crohn’s disease for more than 50 years, and for which an end-ileostomy for 14 years presented an exophytic lesion at the left side of the ileostomy (arrow). Biopsy of the lesion showed adenocarcinoma of intestinal origin