Abstract
Simple SummaryCrohn’s disease (CD) is a chronic inflammatory bowel disease affecting both young and elderly patients, involving the entire gastrointestinal tract from the mouth to anus. The chronic transmural inflammation can lead to several complications, among which gastrointestinal cancers represent one of the most life-threatening, with a higher risk of onset as compared to the general population. Moreover, diagnostic and therapeutic strategies in this subset of patients still represent a significant challenge for physicians. Thus, the aim of this review is to provide a comprehensive overview of the current evidence for an adequate diagnostic pathway and medical and surgical management of CD patients after gastrointestinal cancer onset.Crohn’s disease (CD) is a chronic inflammatory bowel disease with a progressive course, potentially affecting the entire gastrointestinal tract from mouth to anus. Several studies have shown an increased risk of both intestinal and extra-intestinal cancer in patients with CD, due to long-standing transmural inflammation and damage accumulation. The similarity of symptoms among CD, its related complications and the de novo onset of gastrointestinal cancer raises difficulties in the differential diagnosis. In addition, once a cancer diagnosis in CD patients is made, selecting the appropriate treatment can be particularly challenging. Indeed, both surgical and oncological treatments are not always the same as that of the general population, due to the inflammatory context of the gastrointestinal tract and the potential exacerbation of gastrointestinal symptoms of patients with CD; moreover, the overlap of the neoplastic disease could lead to adjustments in the pharmacological treatment of the underlying CD, especially with regard to immunosuppressive drugs. For these reasons, a case-by-case analysis in a multidisciplinary approach is often appropriate for the best diagnostic and therapeutic evaluation of patients with CD after gastrointestinal cancer onset.
Highlights
Crohn’s Disease (CD) is a chronic, relapsing–remitting disease, which can affect the entire gastrointestinal tract with transmural inflammation [1,2,3]
CD patients have an increased risk of both intestinal and extra-intestinal cancers compared to the general population [7,8,9] and chronic inflammation has been identified as the main risk factor for cancerization [10,11,12]
A Danish historical cohort study, including about 50,000 Inflammatory Bowel Disease (IBD) patients over a period of more than 30 years, revealed a higher incidence of malignancies in patients affected by CD, with a Standardized Incidence Ratio (SIR) of 1.3, compared to the general population; notably, in the same study, CD patients appeared to have an increased risk of cancer compared to ulcerative colitis (UC) patients [14]
Summary
Crohn’s Disease (CD) is a chronic, relapsing–remitting disease, which can affect the entire gastrointestinal tract with transmural inflammation [1,2,3]. A Danish historical cohort study, including about 50,000 Inflammatory Bowel Disease (IBD) patients over a period of more than 30 years, revealed a higher incidence of malignancies in patients affected by CD, with a Standardized Incidence Ratio (SIR) of 1.3 (95% CI 1.2–1.4), compared to the general population; notably, in the same study, CD patients appeared to have an increased risk of cancer compared to ulcerative colitis (UC) patients [14]. In comparison to the general population, CD-related CRC usually appears at an earlier age (40–50 years vs 60 years) [27], with a higher incidence in case of CD onset before 15 years of age [14]. The sub-analysis of patients suitable for current surveillance programs revealed an increased mortality rate in case of CD onset before 40 years of age, colonic involvement and coexisting primary sclerosing cholangitis (PSC) [31]
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