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Review
. 2023 Mar 15;37(1):22-29.
doi: 10.1055/s-0043-1762560. eCollection 2024 Jan.

Focal Cancer in Colitis

Cyrena C Lam  1 , William Kethman  1
Affiliations
Review

Focal Cancer in Colitis

Cyrena C Lam et al. Clin Colon Rectal Surg. .

Abstract

Colorectal cancer (CRC) is a known complication of inflammatory bowel disease (IBD). Widely accepted guidelines recommend that patients with ulcerative colitis diagnosed with CRC undergo total proctocolectomy with or without ileal pouch-anal anastomosis, and that patients with Crohn's disease and CRC undergo either total colectomy or proctocolectomy. These approaches are ideal for preventing synchronous and metachronous cancer, minimizing risk of refractory colitis requiring reoperation, and is the appropriate treatment for the vast majority of patients with IBD who are diagnosed with CRC and require surgical intervention. Segmental colectomy, however, may be considered in select patients with IBD and CRC, specifically in elderly patients with short disease duration, in patients with mild colitis identified preoperatively, in patients with high operative risk and prohibitive comorbidities, and in patients whose CRC appears to be sporadic as opposed to colitis-associated. Patients undergoing segmental resection must be closely surveilled postoperatively for dysplasia, recurrent cancer, and refractory colitis.

Keywords: colorectal cancer; inflammatory bowel disease; metachronous cancer; segmental colectomy; synchronous cancer.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Mayo endoscopic score 3. Severe disease with spontaneous bleeding and ulceration in a patient with inflammatory bowel disease.
Fig. 2
Fig. 2
Sporadic appearing adenoma in a patient with ulcerative colitis.
Fig. 3
Fig. 3
Flat dysplasia seen on surveillance colonoscopy in a patient with ulcerative colitis.
Fig. 4
Fig. 4
Invisible dysplasia. Random biopsies taken in the descending colon of this patient with inflammatory bowel disease revealed high-grade dysplasia.
See this image and copyright information in PMC

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