Abstract
Ulcerative colitis (UC) is a risk factor for the development of inflammation-associated dysplasia or colitis-associated neoplasia (CAN). This transformation results from chronic inflammation, which induces changes in epithelial proliferation, survival, and migration via the induction of chemokines and cytokines. There are notable differences in genetic mutation profiles between CAN in UC patients and sporadic colorectal cancer in the general population. Colonoscopy is the cornerstone for surveillance and management of dysplasia in these patients. There are several modalities to augment the quality of endoscopy for the better detection of dysplastic or neoplastic lesions, including the use of high-definition white-light exam and image-enhanced colonoscopy, which are described in this review. Clinical practice guidelines regarding surveillance strategies in UC have been put forth by various GI societies, and overall, there is agreement between them except for some differences, which we highlight in this article. These guidelines recommend that endoscopically detected dysplasia, if feasible, should be resected endoscopically. Advanced newer techniques, such as endoscopic mucosal resection and endoscopic submucosal dissection, have been utilized in the treatment of CAN. Surgery has traditionally been the mainstay of treating such advanced lesions, and in cases where endoscopic resection is not feasible, a proctocolectomy, followed by ileal pouch-anal anastomosis, is generally recommended. In this review we summarize the approach to surveillance for cancer and dysplasia in UC. We also highlight management strategies if dysplasia is detected.
Highlights
Colorectal cancer (CRC) is the third most common cancer and the second most common cause of cancer-related death in the United States [1]
Most CRCs in ulcerative colitis (UC) are suspected to arise from inflammation-associated dysplasia rather than sporadic adenomas; alternative surveillance recommendations have been developed for this patient population
Compliance with initial colitis-associated neoplasia (CAN) screening is relatively high among UC patients at roughly 90%; there is a decline on subsequent examinations, with 76% to 78% of patients being up to date on colonoscopy
Summary
Colorectal cancer (CRC) is the third most common cancer and the second most common cause of cancer-related death in the United States [1]. Most CRCs in UC are suspected to arise from inflammation-associated dysplasia rather than sporadic adenomas; alternative surveillance recommendations have been developed for this patient population. Compliance with initial CAN screening is relatively high among UC patients at roughly 90%; there is a decline on subsequent examinations, with 76% to 78% of patients being up to date on colonoscopy. This decline is still better when compared to the 68.8% of the general population who are up to date on their screening colonoscopy for colon cancer [13,14,15]. We describe the pathogenesis of CAN, surveillance modalities and intervals, and the management of dysplasia and neoplasia
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