Cancer in inflammatory bowel disease.

Abstract

Cancer in inflammatory bowel disease is clearly increased in incidence in the intestinal tract, and probably in certain extraintestinal sites as well. The absolute number of patients developing such malignancies are low compared to overall cancer rates in the general population, but because of higher relative risks, younger ages of onset, distinctive clinicopathological features, and the difficulties of making a diagnosis, it is important that this complication of inflammatory bowel disease be widely appreciated. The prognosis today is no worse for colorectal cancer in ulcerative colitis, and only slightly poorer for Crohn’s colorectal cancer (especially for those occurring in excluded bowel) than forde novo cancers of the large bowel, but it remains exceedingly poor for small bowel cancers in Crohn’s disease. Surveillance can probably be advised for ulcerative colitis-related colorectal cancers, but there is still doubt as to whether it will be costeffective or how it will affect prognosis and survival. There is even greater doubt concerning its role in monitoring patients with Crohn’s colorectal cancer, or small bowel cancers. A cooperative study of endoscopic surveillance to diagnose dysplasia or malignant change in the mucosa of patients with Crohn’s disease has yet to be widely accepted as a worthwhile idea, much less actually designed or undertaken.