Download PDF
Clin Colon Rectal Surg 2024; 37(01): 013-017
DOI: 10.1055/s-0043-1762558
Review Article

What Is the Risk? Epidemiology and Evidence for Surveillance Regimens

Bianca Islam
1   Department of Internal Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
,
Vu Nguyen
1   Department of Internal Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Patients with inflammatory bowel disease (IBD) have increased risk of colorectal cancer (CRC). The risk for CRC is positively correlated to the duration of disease, extent of colonic involvement, and severity of inflammation. After 8 to 10 years of IBD diagnosis, the risk for CRC rises substantially and screening colonoscopy is recommended. Surveillance colonoscopy interval ranges from 1 to 5 years depending on patient and disease-specific risk factors. IBD patients with high risk factors such as having concomitant primary sclerosing cholangitis, moderate-to-severe inflammation, first-degree relative with CRC at early age, or history of invisible dysplasia or high-risk visible dysplasia should undergo surveillance colonoscopy in 1 year. Meanwhile, those with minimal colonic involvement or ≥2 consecutive unremarkable examinations while in continuous remission may consider extending the surveillance interval to 5 years. Advance in colonoscopy technique such as chromoendoscopy using dyes and/or image digital processing (virtual chromoendoscopy) may enhance dysplasia detection and is the preferred method for IBD surveillance. In the era of high-definition colonoscope, the practice of obtaining extensive biopsies throughout the colon remains controversial but is generally recommended to improve the detection rate of invisible dysplasia. Endoscopic surveillance in IBD has been shown to result in earlier detection of CRC and improved prognosis.

Keywords

inflammatory bowel disease - colorectal cancer - risk factors - surveillance - chromoendoscopy


Publication History

Article published online:
08 March 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2021. CA Cancer J Clin 2021; 71 (01) 7-33
    CrossrefPubMedGoogle Scholar
  • 2 Molodecky NA, Soon IS, Rabi DM. et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology 2012; 142 (01) 46-54.e42 , quiz e30
    CrossrefPubMedGoogle Scholar
  • 3 Munkholm P. Review article: the incidence and prevalence of colorectal cancer in inflammatory bowel disease. Aliment Pharmacol Ther 2003; 18 (Suppl. 02) 1-5
    CrossrefPubMedGoogle Scholar
  • 4 Eaden JA, Abrams KR, Mayberry JF. The risk of colorectal cancer in ulcerative colitis: a meta-analysis. Gut 2001; 48 (04) 526-535
    CrossrefPubMedGoogle Scholar
  • 5 Canavan C, Abrams KR, Mayberry J. Meta-analysis: colorectal and small bowel cancer risk in patients with Crohn's disease. Aliment Pharmacol Ther 2006; 23 (08) 1097-1104
    CrossrefPubMedGoogle Scholar
  • 6 Wan Q, Zhao R, Xia L. et al. Inflammatory bowel disease and risk of gastric, small bowel and colorectal cancer: a meta-analysis of 26 observational studies. J Cancer Res Clin Oncol 2021; 147 (04) 1077-1087
    CrossrefPubMedGoogle Scholar
  • 7 Lutgens MWMD, van Oijen MGH, van der Heijden GJMG, Vleggaar FP, Siersema PD, Oldenburg B. Declining risk of colorectal cancer in inflammatory bowel disease: an updated meta-analysis of population-based cohort studies. Inflamm Bowel Dis 2013; 19 (04) 789-799
    CrossrefPubMedGoogle Scholar
  • 8 Watanabe T, Konishi T, Kishimoto J, Kotake K, Muto T, Sugihara K. Japanese Society for Cancer of the Colon and Rectum. Ulcerative colitis-associated colorectal cancer shows a poorer survival than sporadic colorectal cancer: a nationwide Japanese study. Inflamm Bowel Dis 2011; 17 (03) 802-808
    CrossrefPubMedGoogle Scholar
  • 9 Olén O, Erichsen R, Sachs MC. et al. Colorectal cancer in ulcerative colitis: a Scandinavian population-based cohort study. Lancet 2020; 395 (10218): 123-131
    CrossrefPubMedGoogle Scholar
  • 10 Ekbom A, Helmick C, Zack M, Adami HO. Increased risk of large-bowel cancer in Crohn's disease with colonic involvement. Lancet 1990; 336 (8711): 357-359
    CrossrefPubMedGoogle Scholar
  • 11 Ekbom A, Helmick C, Zack M, Adami HO. Ulcerative colitis and colorectal cancer. A population-based study. N Engl J Med 1990; 323 (18) 1228-1233
    CrossrefPubMedGoogle Scholar
  • 12 Langholz E, Munkholm P, Davidsen M, Binder V. Colorectal cancer risk and mortality in patients with ulcerative colitis. Gastroenterology 1992; 103 (05) 1444-1451
    CrossrefPubMedGoogle Scholar
  • 13 Rutter M, Saunders B, Wilkinson K. et al. Severity of inflammation is a risk factor for colorectal neoplasia in ulcerative colitis. Gastroenterology 2004; 126 (02) 451-459
    CrossrefPubMedGoogle Scholar
  • 14 Gupta RB, Harpaz N, Itzkowitz S. et al. Histologic inflammation is a risk factor for progression to colorectal neoplasia in ulcerative colitis: a cohort study. Gastroenterology 2007; 133 (04) 1099-1105 , quiz 1340–1341
    CrossrefPubMedGoogle Scholar
  • 15 Baars JE, Looman CWN, Steyerberg EW. et al. The risk of inflammatory bowel disease-related colorectal carcinoma is limited: results from a nationwide nested case-control study. Am J Gastroenterol 2011; 106 (02) 319-328
    CrossrefPubMedGoogle Scholar
  • 16 Velayos FS, Loftus Jr EV, Jess T. et al. Predictive and protective factors associated with colorectal cancer in ulcerative colitis: a case-control study. Gastroenterology 2006; 130 (07) 1941-1949
    CrossrefPubMedGoogle Scholar
  • 17 Mahmoud R, Shah SC, Ten Hove JR. et al; Dutch Initiative on Crohn and Colitis. No association between pseudopolyps and colorectal neoplasia in patients with inflammatory bowel diseases. Gastroenterology 2019; 156 (05) 1333-1344.e3
    CrossrefPubMedGoogle Scholar
  • 18 Barberio B, Massimi D, Cazzagon N, Zingone F, Ford AC, Savarino EV. Prevalence of primary sclerosing cholangitis in patients with inflammatory bowel disease: a systematic review and meta-analysis. Gastroenterology 2021; 161 (06) 1865-1877
    CrossrefPubMedGoogle Scholar
  • 19 Zheng H-H, Jiang X-L. Increased risk of colorectal neoplasia in patients with primary sclerosing cholangitis and inflammatory bowel disease: a meta-analysis of 16 observational studies. Eur J Gastroenterol Hepatol 2016; 28 (04) 383-390
    CrossrefPubMedGoogle Scholar
  • 20 Claessen MMH, Vleggaar FP, Tytgat KMAJ, Siersema PD, van Buuren HR. High lifetime risk of cancer in primary sclerosing cholangitis. J Hepatol 2009; 50 (01) 158-164
    CrossrefPubMedGoogle Scholar
  • 21 Lamb CA, Kennedy NA, Raine T. et al; IBD guidelines eDelphi consensus group. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut 2019; 68 (Suppl. 03) s1-s106
    CrossrefPubMedGoogle Scholar
  • 22 Magro F, Gionchetti P, Eliakim R. et al; European Crohn's and Colitis Organisation [ECCO]. Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 1: definitions, diagnosis, extra-intestinal manifestations, pregnancy, cancer surveillance, surgery, and ileo-anal pouch disorders. J Crohn's Colitis 2017; 11 (06) 649-670
    CrossrefPubMedGoogle Scholar
  • 23 Murthy SK, Feuerstein JD, Nguyen GC, Velayos FS. AGA clinical practice update on endoscopic surveillance and management of colorectal dysplasia in inflammatory bowel diseases: expert review. Gastroenterology 2021; 161 (03) 1043-1051.e4
    CrossrefPubMedGoogle Scholar
  • 24 Ooi CJ, Makharia GK, Hilmi I. et al; Asia Pacific Association of Gastroenterology (APAGE) Working Group on Inflammatory Bowel Disease. Asia-Pacific consensus statements on Crohn's disease. Part 2: management. J Gastroenterol Hepatol 2016; 31 (01) 56-68
    CrossrefPubMedGoogle Scholar
  • 25 Collins PD, Mpofu C, Watson AJ, Rhodes JM. Strategies for detecting colon cancer and/or dysplasia in patients with inflammatory bowel disease. Cochrane Database Syst Rev 2006; (02) CD000279
    PubMedGoogle Scholar
  • 26 Derikx LAAP, Nissen LHC, Smits LJT, Shen B, Hoentjen F. Risk of neoplasia after colectomy in patients with inflammatory bowel disease: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2016; 14 (06) 798-806.e20
    CrossrefPubMedGoogle Scholar
  • 27 Selvaggi F, Pellino G, Canonico S, Sciaudone G. Systematic review of cuff and pouch cancer in patients with ileal pelvic pouch for ulcerative colitis. Inflamm Bowel Dis 2014; 20 (07) 1296-1308
    CrossrefPubMedGoogle Scholar
  • 28 Das P, Johnson MW, Tekkis PP, Nicholls RJ. Risk of dysplasia and adenocarcinoma following restorative proctocolectomy for ulcerative colitis. Colorectal Dis 2007; 9 (01) 15-27
    CrossrefPubMedGoogle Scholar
  • 29 Kariv R, Remzi FH, Lian L. et al. Preoperative colorectal neoplasia increases risk for pouch neoplasia in patients with restorative proctocolectomy. Gastroenterology 2010; 139 (03) 806-812 , 812.e1–812.e2
    CrossrefPubMedGoogle Scholar
  • 30 Laine L, Kaltenbach T, Barkun A, McQuaid KR, Subramanian V, Soetikno R. SCENIC Guideline Development Panel. SCENIC international consensus statement on surveillance and management of dysplasia in inflammatory bowel disease. Gastroenterology 2015; 148 (03) 639-651.e28
    CrossrefPubMedGoogle Scholar
  • 31 Alexandersson B, Hamad Y, Andreasson A. et al. High-definition chromoendoscopy superior to high-definition white-light endoscopy in surveillance of inflammatory bowel diseases in a randomized trial. Clin Gastroenterol Hepatol 2020; 18 (09) 2101-2107
    CrossrefPubMedGoogle Scholar
  • 32 Endoscopic Classification Review Group. Update on the Paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy 2005; 37 (06) 570-578
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 El-Dallal M, Chen Y, Lin Q. et al. Meta-analysis of virtual-based chromoendoscopy compared with dye-spraying chromoendoscopy standard and high-definition white light endoscopy in patients with inflammatory bowel disease at increased risk of colon cancer. Inflamm Bowel Dis 2020; 26 (09) 1319-1329
    CrossrefPubMedGoogle Scholar
  • 34 Rubin CE, Haggitt RC, Burmer GC. et al. DNA aneuploidy in colonic biopsies predicts future development of dysplasia in ulcerative colitis. Gastroenterology 1992; 103 (05) 1611-1620
    CrossrefPubMedGoogle Scholar
  • 35 Watanabe T, Ajioka Y, Mitsuyama K. et al. Comparison of targeted vs random biopsies for surveillance of ulcerative colitis-associated colorectal cancer. Gastroenterology 2016; 151 (06) 1122-1130
    CrossrefPubMedGoogle Scholar
  • 36 Hassan C, Spadaccini M, Iannone A. et al. Performance of artificial intelligence in colonoscopy for adenoma and polyp detection: a systematic review and meta-analysis. Gastrointest Endosc 2021; 93 (01) 77-85.e6
    CrossrefPubMedGoogle Scholar
  • 37 Sundaram S, Choden T, Mattar MC, Desai S, Desai M. Artificial intelligence in inflammatory bowel disease endoscopy: current landscape and the road ahead. Ther Adv Gastrointest Endosc 2021;14:26317745211017809
    PubMedGoogle Scholar