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Large bowel cancer in the setting of inflammatory bowel disease

Features and management with a focus on rectal cancer

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Summary

Background

Inflammatory bowel diseases (IBDs) are a well-known risk factor for the development of colorectal cancer (CRC). This risk relates to different aspects of the disease, such as the duration, activity, and extension, and tends to increase in the presence of associated conditions, such as family history of CRC or some extra-intestinal manifestations. Rectal cancer (RC) in IBD has been poorly investigated.

Methods

We reviewed the scientific literature for data on the features and management of RC in the setting of IBD. Here, we provide a practical insight into the diagnosis and management of the condition.

Results

Several genetic and environmental factors promote the development of CRC, including alterations of intestinal microflora and mutations in the genes responsible for the cell cycle and for DNA mismatch repair. Dysplasia is the main evidence of a clear conversion of normal epithelium to cancer. Dysplasia is often multifocal, in contrast to sporadic CRC, which explains the tendency toward the development of synchronous and metachronous CRC in patients with IBD. Other conditions that need attention are strictures, for which the threshold for surgery must be low. Treatment of RC in patients with IBD follows the same oncologic criteria as non-IBD-related RC, but patients are often diagnosed at more advanced stages, suggesting that this is frequently overlooked. This is ultimately associated with poorer outcomes in IBD patients.

Conclusion

There is a pressing need for more data on IBD-related RC. Implementing knowledge will result in optimization of survival for these patients.

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Abbreviations

5-ASA:

5-aminosalicylic acid

APE:

Abdominoperineal excision

CCFA:

Crohn’s and Colitis Foundation of America

CD:

Crohn’s disease

CI:

Confidence intervals

CIN:

Chromosomal instability

COX-2:

Cyclo-oxygenase-2

CRC:

Colorectal cancer

DALM:

Dysplasia-associated lesion or mass

FAP:

Familial adenomatous polyposis

HGD:

High-grade dysplasia

HNPCC:

Hereditary non-polyposis colorectal cancer syndrome

IBD:

Inflammatory bowel disease

IPAA:

Ileal pouch–anal anastomosis

LGD:

Low-grade dysplasia

MSI:

Micro satellites instability

NOS:

Nitric oxide synthase

OR:

Odds ratio

PSC:

Primary sclerosing cholangitis

RC:

Rectal cancer

RONS:

Reactive oxygen and nitrogen species

SIR:

Standardized incidence ratio

UC:

Ulcerative colitis

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Authors and Affiliations

  1. Unit of Colorectal Surgery, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples, Via F. Giordani, 42, 80122, Naples, Italy

    Gianluca Pellino MD, Rosa Marcellinaro MD, Guido Sciaudone MD & Francesco Selvaggi MD

  2. Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Naples, Italy

    Alfonso Reginelli MD PhD

  3. Unit of Gastroenterology, Second University of Naples, Naples, Italy

    Pasquale Esposito MD & Gabriele Riegler MD

  4. Unit of General and Geriatric Surgery, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples, Naples, Italy

    Silvestro Canonico MD

  5. Pathology Section, Department of Molecular and Translational Medicine, Spedali Civili and University of Brescia, Perugia, Italy

    Vincenzo Villanacci MD

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  1. Gianluca Pellino MD
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  2. Rosa Marcellinaro MD
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  3. Guido Sciaudone MD
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  4. Alfonso Reginelli MD PhD
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  5. Pasquale Esposito MD
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  6. Gabriele Riegler MD
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  7. Silvestro Canonico MD
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  8. Vincenzo Villanacci MD
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  9. Francesco Selvaggi MD
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Correspondence to Francesco Selvaggi MD.

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G. Pellino, R. Marcellinaro, G. Sciaudone, A. Reginelli, P. Esposito, G. Riegler, S. Canonico, V. Villanacci, and F. Selvaggi declare that they have no competing interests.

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Pellino, G., Marcellinaro, R., Sciaudone, G. et al. Large bowel cancer in the setting of inflammatory bowel disease. Eur Surg 48, 191–202 (2016). https://doi.org/10.1007/s10353-016-0434-0

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