Abstract
Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) associated with multiple colonic and extraintestinal complications, the most severe being the development of colorectal cancer (CRC). Compared to the general population, there is an increased risk of CRC associated with UC. Although the pathogenesis of CRC in UC is unknown, most studies have linked it to long-standing inflammation as well as other risk factors such as duration of disease, extent of inflammation, family history of CRC, and coexisting conditions such as primary sclerosing cholangitis (PSC). UC is a life-long disease for which patients enter a vigilant screening program which includes surveillance colonoscopy to promote early detection of CRC yet some controversies exist regarding the cost effectiveness of surveillance colonoscopy and improving survival. Newer modalities such as chromoendoscopy, narrow band imaging, high definition colonoscopy, and confocal microscopy have aided in developing a more targeted approach for early detection of dysplasia in surveillance colonoscopy. This review focuses on the role of chronic colonic inflammation and dysplasia in development of UC-associated CRC and current methods of screening, detection, chemoprevention, and treatment of UC-associated CRC.
Highlights
Ulcerative Colitis (UC) is one of two types of inflammatory bowel disease (IBD) with disease limited to the colonic mucosa
The study was able to determine that there was a dramatic increase in development of colorectal cancer (CRC) in long-standing UC when compared to the general population which the Office of National Statistics reported as 0.06%
These studies indicated that there was a dramatic increase in the risk of developing CRC in long-standing UC when compared to the general population, and those with extensive disease were at the highest risk [2]
Summary
Ulcerative Colitis (UC) is one of two types of inflammatory bowel disease (IBD) with disease limited to the colonic mucosa. While the exact pathogenesis behind the development of colitis related CRC has not been identified, studies have shown it is most likely a result of chronic inflammation that leads to progressive dysplasia and eventually adenocarcinoma. This neoplastic process typically begins after a long duration of disease of 8 to 10 years and it can occur despite excellent control of most UC disease symptoms and even control of colonic inflammation by medications [4]. DALM lesions are elevated areas known to have an increased risk for the development of adenocarcinoma in UC [8] and should practically be considered malignant and be managed like a cancer. This review article will mainly focus on the increased risk, surveillance, and chemoprevention of CRC in patients with UC
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