Clin Colon Rectal Surg
DOI: 10.1055/s-0044-1787891
Review Article

Colorectal Cancer and Inflammatory Bowel Disease

Maysoon Gamaleldin
1   Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio
,
Taha Qazi
2   Department of Gastroenterology, Cleveland Clinic, Cleveland, Ohio
,
Tracy Hull
1   Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio
› Author Affiliations

Abstract

Colorectal cancer (CRC) in patients with ulcerative colitis (UC) and Crohn's disease accounts for ∼5% of all cases of CRC. Although it only accounts for a fraction of CRC cases, inflammatory bowel disease (IBD)-related CRC is a serious consequence of chronic inflammation that needs attention. There is a better understanding today about the pathogenesis contributing to IBD-CRC and the role of genetics and gut microbiota. Guidelines recommend timely screening and surveillance of UC and Crohn's patients, and it is usually timed from the initial diagnosis. This helps with early detection of dysplasia and CRC in this subset of patients, thus allowing for earlier intervention. However, dysplasia is not always easy to discern and management of CRC in each patient may differ. A multidisciplinary approach should be adopted in managing CRC in IBD. Although the oncologic principles of managing sporadic CRC and IBD-CRC are the same, surgical resection should be tailored to each patient.



Publication History

Article published online:
24 June 2024

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  • References

  • 1 Crohn BB, Rosenberg H. The sigmoidoscopic picture of chronic ulcerative colitis. Am J Med Sci 1925; 170: 220-228
  • 2 Lu C, Schardey J, Zhang T. et al. Survival outcomes and clinicopathological features in inflammatory bowel disease-associated colorectal cancer: a systematic review and meta-analysis. Ann Surg 2022; 276 (05) e319-e330
  • 3 Mattar MC, Lough D, Pishvaian MJ, Charabaty A. Current management of inflammatory bowel disease and colorectal cancer. Gastrointest Cancer Res 2011; 4 (02) 53-61
  • 4 Fornaro R, Caratto M, Caratto E. et al. Colorectal cancer in patients with inflammatory bowel disease: the need for a real surveillance program. Clin Colorectal Cancer 2016; 15 (03) 204-212
  • 5 Eaden JA, Abrams KR, Mayberry JF. The risk of colorectal cancer in ulcerative colitis: a meta-analysis. Gut 2001; 48 (04) 526-535
  • 6 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
  • 7 Feagins LA, Souza RF, Spechler SJ. Carcinogenesis in IBD: potential targets for the prevention of colorectal cancer. Nat Rev Gastroenterol Hepatol 2009; 6 (05) 297-305
  • 8 Frigerio S, Lartey DA, D'Haens GR, Grootjans J. The role of the immune system in IBD-associated colorectal cancer: from pro to anti-tumorigenic mechanisms. Int J Mol Sci 2021; 22 (23) 12739
  • 9 Renz BW, Thasler WE, Preissler G. et al. Clinical outcome of IBD-associated versus sporadic colorectal cancer: a matched-pair analysis. J Gastrointest Surg 2013; 17 (05) 981-990
  • 10 Ording AG, Horváth-Puhó E, Erichsen R. et al. Five-year mortality in colorectal cancer patients with ulcerative colitis or Crohn's disease: a nationwide population-based cohort study. Inflamm Bowel Dis 2013; 19 (04) 800-805
  • 11 Yu LCH. Microbiota dysbiosis and barrier dysfunction in inflammatory bowel disease and colorectal cancers: exploring a common ground hypothesis. J Biomed Sci 2018; 25 (01) 79
  • 12 Marion JF, Waye JD, Israel Y. et al; Chromoendoscopy Study Group at Mount Sinai School of Medicine. Chromoendoscopy is more effective than standard colonoscopy in detecting dysplasia during long-term surveillance of patients with colitis. Clin Gastroenterol Hepatol 2016; 14 (05) 713-719
  • 13 Ullman T, Odze R, Farraye FA. Diagnosis and management of dysplasia in patients with ulcerative colitis and Crohn's disease of the colon. Inflamm Bowel Dis 2009; 15 (04) 630-638
  • 14 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
  • 15 Soetikno RM, Lin OS, Heidenreich PA, Young HS, Blackstone MO. Increased risk of colorectal neoplasia in patients with primary sclerosing cholangitis and ulcerative colitis: a meta-analysis. Gastrointest Endosc 2002; 56 (01) 48-54
  • 16 Magro F, Doherty G, Peyrin-Biroulet L. et al. ECCO Position Paper: harmonization of the approach to ulcerative colitis histopathology. J Crohn's Colitis 2020; 14 (11) 1503-1511
  • 17 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
  • 18 Shapiro BD, Lashner BA. Cancer biology in ulcerative colitis and potential use in endoscopic surveillance. Gastrointest Endosc Clin N Am 1997; 7 (03) 453-468
  • 19 Karlén P, Kornfeld D, Broström O, Löfberg R, Persson PG, Ekbom A. Is colonoscopic surveillance reducing colorectal cancer mortality in ulcerative colitis? A population based case control study. Gut 1998; 42 (05) 711-714
  • 20 Lutgens MWMD, Oldenburg B, Siersema PD. et al. Colonoscopic surveillance improves survival after colorectal cancer diagnosis in inflammatory bowel disease. Br J Cancer 2009; 101 (10) 1671-1675
  • 21 Choi CHR, Rutter MD, Askari A. et al. Forty-year analysis of colonoscopic surveillance program for neoplasia in ulcerative colitis: an updated overview. Am J Gastroenterol 2015; 110 (07) 1022-1034
  • 22 Baars JE, Vogelaar L, Wolfhagen FHJ, Biermann K, Kuipers EJ, van der Woude CJ. A short course of corticosteroids prior to surveillance colonoscopy to decrease mucosal inflammation in inflammatory bowel disease patients: results from a randomized controlled trial. J Crohn's Colitis 2010; 4 (06) 661-668
  • 23 Torres J, Pineton de Chambrun G, Itzkowitz S, Sachar DB, Colombel JF. Review article: colorectal neoplasia in patients with primary sclerosing cholangitis and inflammatory bowel disease. Aliment Pharmacol Ther 2011; 34 (05) 497-508
  • 24 Askling J, Dickman PW, Karlén P. et al. Family history as a risk factor for colorectal cancer in inflammatory bowel disease. Gastroenterology 2001; 120 (06) 1356-1362
  • 25 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
  • 26 Holubar SD, Lightner AL, Poylin V. et al; Prepared on behalf of the Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the surgical management of ulcerative colitis. Dis Colon Rectum 2021; 64 (07) 783-804
  • 27 Annese V, Daperno M, Rutter MD. et al; European Crohn's and Colitis Organisation. European evidence based consensus for endoscopy in inflammatory bowel disease. J Crohn's Colitis 2013; 7 (12) 982-1018
  • 28 Clarke WT, Feuerstein JD. Colorectal cancer surveillance in inflammatory bowel disease: Practice guidelines and recent developments. World J Gastroenterol 2019; 25 (30) 4148-4157
  • 29 Kornbluth A, Sachar DB. Practice Parameters Committee of the American College of Gastroenterology. Ulcerative colitis practice guidelines in adults: American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol 2010; 105 (03) 501-523 , quiz 524
  • 30 Rubin DT, Ananthakrishnan AN, Siegel CA, Sauer BG, Long MD. ACG Clinical Guideline: ulcerative colitis in adults. Am J Gastroenterol 2019; 114 (03) 384-413
  • 31 Bernstein CN, Shanahan F, Weinstein WM. Are we telling patients the truth about surveillance colonoscopy in ulcerative colitis?. Lancet 1994; 343 (8889) 71-74
  • 32 Bogach J, Pond G, Eskicioglu C, Simunovic M, Seow H. Extent of surgical resection in inflammatory bowel disease associated colorectal cancer: a population-based study. J Gastrointest Surg 2021; 25 (10) 2610-2618
  • 33 Øresland T, Bemelman WA, Sampietro GM. et al; European Crohn's and Colitis Organisation (ECCO). European evidence based consensus on surgery for ulcerative colitis. J Crohn's Colitis 2015; 9 (01) 4-25
  • 34 Wu XR, Kiran RP, Remzi FH, Katz S, Mukewar S, Shen B. Preoperative pelvic radiation increases the risk for ileal pouch failure in patients with colitis-associated colorectal cancer. J Crohn's Colitis 2013; 7 (10) e419-e426
  • 35 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