Abstract
Simple SummaryPatients with inflammatory bowel disease are at an increased risk of developing colorectal cancer, and so are enrolled in a surveillance colonoscopy programme aimed at detecting and treating any signs of early cancer. This review describes the current known risk factors associated with this increased risk, explores our current molecular understanding of cancer development and reviews potential new methods (molecular and technological) designed to help the surveillance programme.Patients with colonic inflammatory bowel disease (IBD) are at an increased risk of developing colorectal cancer (CRC), and are therefore enrolled into a surveillance programme aimed at detecting dysplasia or early cancer. Current surveillance programmes are guided by clinical, endoscopic or histological predictors of colitis-associated CRC (CA-CRC). We have seen great progress in our understanding of these predictors of disease progression, and advances in endoscopic technique and management, along with improved medical care, has been mirrored by the falling incidence of CA-CRC over the last 50 years. However, more could be done to improve our molecular understanding of CA-CRC progression and enable better risk stratification for patients with IBD. This review summarises the known risk factors associated with CA-CRC and explores the molecular landscape that has the potential to complement and optimise the existing IBD surveillance programme.
Highlights
Meta-analysis suggests that Faecal calprotectin (FC) has good utility in diagnosing Inflammatory bowel disease (IBD); it was not recommended as a predictive biomarker for CACRC [110]
This study demonstrates that plasma Cell-Free DNA (cfDNA) concentrations significantly correlate with other inflammatory markers, such as the percentage of neutrophils (p = 0.0079) and C-reactive protein (CRP) (p = 0.0052), as well as being positively correlated with the clinical severity of ulcerative colitis (UC) [210]
The introduction of a surveillance programme, advances in medical care and endoscopic technology, recognising clinical risk factors strongly predictive of CA-colorectal cancer (CRC) and tailoring surveillance has no doubt contributed to the falling incidence of this most feared complication in patients with IBD over the years
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Despite uncertainty about the precise CRC incidence in IBD, the overall association between IBD and an increased risk of developing CRC is well established and largely accepted in clinical practice [6,7,17], IBD patients are enrolled into endoscopic surveillance programmes that aim to detect early signs of cancer and offer treatment to patients in a timely manner It has been more than 40 years since the IBD colonoscopy surveillance program was introduced in the UK [18], and the aforementioned studies that report the declining incidence of colitis-associated CRC (CA-CRC) may reflect the advances in endoscopic surveillance across this time. We highlight the potential new methods of assisting and optimising the surveillance programme so we can best predict cancer occurrence
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