Caecal cancer associated with longstanding Crohn's disease

Abstract

in patients with ulcerative colitis; however, the risk of intestinal cancer in Crohn’s disease was uncertain until two recent meta-analyses suggested an association between Crohn’s disease and intestinal cancer. 2,3 Notably, there appears to be an increasing number of patients at risk of developing intestinal cancer because prevalence and incidence rates of Crohn’s disease in the general population have been increasing. Therefore, we should consider long-standing Crohn’s disease as a high-risk condition for development of intestinal cancer. However, newer therapies for Crohn’s disease, such as biological agents, may aff ect the natural history of the disease. Future prospective studies, taking new treatment strategies into account, will provide information about the risk of intestinal cancer in Crohn’s disease. In our case, the patient complained of bloody stools—haematochezia is rare as a clinical sign in right-sided Crohn’s disease and might be a sign of possible cancer, which should justify immediate endoscopic examination. Although mesalazine has cancer-preventive eff ects in ulcerative colitis, its benefi ts in our patient remain un– clear. 4,5 Further investigations are needed to assess its effi cacy in long-standing Crohn’s disease. Moreover, immunohistochemistry for products of the p53 tumour suppression gene might be helpful in diagnosing intestinal cancer associated with Crohn’s disease. There are many reports on an association between the p53 tumour suppressor gene and colorectal cancer in ulcerative colitis, but not in Crohn’s disease. Our case suggests that, as in colorectal cancer associated with ulcerative colitis, mutations of the p53 tumour suppressor gene might have an important role in the development of intestinal cancer in cases of longstanding Crohn’s disease.