Preventing Colorectal Cancer in Patients with Inflammatory Bowel Diseases: Chemopreventive and Surgical Approaches

Abstract

Patients with inflammatory bowel diseases (IBDs) are at increased risk of colorectal cancer (CRC). While several risk factors associated with increased risk of CRC may not be modifiable (coexistent primary sclerosing cholangitis, long disease duration, extensive colitis, young age at diagnosis, family history of CRC), potentially modifiable risk factors include cumulative inflammatory burden and smoking. While chemoprevention is not recommended for preventing CRC in patients with IBD, several pharmacological approaches may be helpful. Effective pharmacotherapy for IBD, including 5-aminosalicylates, thiopurines, and biologic agents, which decreases inflammatory burden is probably effective in decreasing risk of CRC. Non-IBD-related therapies such as aspirin and statins may also be effective, but are not routinely recommended. Among patients with screen-detected low-grade dysplasia, endoscopic eradication techniques, or in some high-risk patients (such as those with multifocal, invisible, persistent dysplasia, coexistent primary sclerosing cholangitis, or unresectable non-polypoid dysplasia), surgical management with total colectomy with end-ileostomy or ileal pouch anal anastomosis may be considered.