Skip to main content
SpringerLink
Log in

Surgical Options for Neoplasia Complicating Crohn’s Disease of the Large Intestine

  • Chapter
  • First Online:
Mastery of IBD Surgery

  • 520 Accesses

Abstract

Individuals with Crohn’s disease (CD) of the large intestine develop colorectal cancer at an increased rate compared to the general population. The exact magnitude of increased risk is unknown. The prevalence of dysplasia at 25 years has been reported to range between 0.5% to 25% and the risk for colorectal cancer may be six-fold that of the general population. Colorectal cancer in patients with inflammatory bowel disease (IBD) appears to develop via a pathway that deviates from the well characterized adenoma-carcinoma sequence of sporadic colorectal cancer and may progress rapidly, skipping steps seen with sporadic colorectal cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

Abbreviations

CC:

Crohn’s colitis

CD:

Crohn’s disease

CRC:

Colorectal cancer

CUC:

Chronic ulcerative colitis

HGD:

High-grade dysplasia

IBD:

Inflammatory bowel disease

IPAA:

Ileal pouch-anal anastomosis

LGD:

Low-grade dysplasia

STC:

Subtotal colectomy

TAC/IRA:

Total abdominal colectomy/ileorectal anastomosis

TPC/EI:

Total proctocolectomy/end ileostomy

References

  1. Bergeron V, Vienne A, Sokol H, et al. Risk factors for neoplasia in inflammatory bowel disease patients with pancolitis. Am J Gastroenterol. 2010;105(11):2405–11.

    Article  Google Scholar 

  2. Eaden JA, Abrams KR, Mayberry JF. The risk of colorectal cancer in ulcerative colitis: a meta-analysis. Gut. 2001;48(4):526–35.

    Article  CAS  Google Scholar 

  3. Canavan C, Abrams KR, Mayberry J. Meta-analysis: colorectal and small bowel cancer risk in patients with Crohn’s disease. Aliment Pharmacol Ther. 2006;23(8):1097–104.

    Article  CAS  Google Scholar 

  4. Jess T, Loftus EV Jr, Velayos FS, et al. Incidence and prognosis of colorectal dysplasia in inflammatory bowel disease: a population-based study from Olmsted County, Minnesota. Inflamm Bowel Dis. 2006;12(8):669–76.

    Article  Google Scholar 

  5. Friedman S, Rubin PH, Bodian C, Harpaz N, Present DH. Screening and surveillance colonoscopy in chronic Crohn’s colitis: results of a surveillance program spanning 25 years. Clin Gastroenterol Hepatol. 2008;6(9):993–8.. quiz 953–994

    Article  Google Scholar 

  6. Ekbom A, Helmick C, Zack M, Adami HO. Increased risk of large-bowel cancer in Crohn’s disease with colonic involvement. Lancet. 1990;336(8711):357–9.

    Article  CAS  Google Scholar 

  7. Jess T, Simonsen J, Jorgensen KT, Pedersen BV, Nielsen NM, Frisch M. Decreasing risk of colorectal cancer in patients with inflammatory bowel disease over 30 years. Gastroenterology. 2012;143(2):375–81.. e371; quiz e313–374

    Article  Google Scholar 

  8. Kappelman MD, Farkas DK, Long MD, et al. Risk of cancer in patients with inflammatory bowel diseases: a nationwide population-based cohort study with 30 years of follow-up evaluation. Clin Gastroenterol Hepatol. 2014;12(2):265–73.. e261

    Article  Google Scholar 

  9. Taylor BA, Pemberton JH, Carpenter HA, et al. Dysplasia in chronic ulcerative colitis: implications for colonoscopic surveillance. Dis Colon Rectum. 1992;35(10):950–6.

    Article  CAS  Google Scholar 

  10. Ullman T, Croog V, Harpaz N, Sachar D, Itzkowitz S. Progression of flat low-grade dysplasia to advanced neoplasia in patients with ulcerative colitis. Gastroenterology. 2003;125(5):1311–9.

    Article  Google Scholar 

  11. Robles AI, Traverso G, Zhang M, et al. Whole-exome sequencing analyses of inflammatory bowel disease-associated colorectal cancers. Gastroenterology. 2016;150(4):931–43.

    Article  CAS  Google Scholar 

  12. Yaeger R, Shah MA, Miller VA, et al. Genomic alterations observed in colitis-associated cancers are distinct from those found in sporadic colorectal cancers and vary by type of inflammatory bowel disease. Gastroenterology. 2016;151(2):278–87.. e276

    Article  CAS  Google Scholar 

  13. Bernstein CN, Shanahan F, Weinstein WM. Are we telling patients the truth about surveillance colonoscopy in ulcerative colitis? Lancet. 1994;343(8889):71–4.

    Article  CAS  Google Scholar 

  14. O’Connor PM, Lapointe TK, Beck PL, Buret AG. Mechanisms by which inflammation may increase intestinal cancer risk in inflammatory bowel disease. Inflamm Bowel Dis. 2010;16(8):1411–20.

    Article  Google Scholar 

  15. Farraye FA, Odze RD, Eaden J, et al. AGA medical position statement on the diagnosis and management of colorectal neoplasia in inflammatory bowel disease. Gastroenterology. 2010;138(2):738–45.

    Article  Google Scholar 

  16. American Society for Gastrointestinal Endoscopy Standards of Practice C, Shergill AK, Lightdale JR, et al. The role of endoscopy in inflammatory bowel disease. Gastrointestinal Endosc. 2015;81(5):1101–21.. e1101–1113

    Article  Google Scholar 

  17. Annese V, Daperno M, Rutter MD, et al. European evidence based consensus for endoscopy in inflammatory bowel disease. J Crohns Colitis. 2013;7(12):982–1018.

    Article  Google Scholar 

  18. Colonoscopic Surveillance for Prevention of Colorectal Cancer in People with Ulcerative Colitis, Crohn’s Disease or Adenomas. London 2011.

    Google Scholar 

  19. Strong S, Steele SR, Boutrous M, et al. Clinical practice guideline for the surgical management of Crohn’s disease. Dis Colon Rectum. 2015;58(11):1021–36.

    Article  Google Scholar 

  20. Cairns SR, Scholefield JH, Steele RJ, et al. Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002). Gut. 2010;59(5):666–89.

    Article  Google Scholar 

  21. Maykel JA, Hagerman G, Mellgren AF, et al. Crohn’s colitis: the incidence of dysplasia and adenocarcinoma in surgical patients. Dis Colon Rectum. 2006;49(7):950–7.

    Article  Google Scholar 

  22. Kiran RP, Nisar PJ, Goldblum JR, et al. Dysplasia associated with Crohn’s colitis: segmental colectomy or more extended resection? Ann Surg. 2012;256(2):221–6.

    Article  Google Scholar 

  23. Maser EA, Sachar DB, Kruse D, Harpaz N, Ullman T, Bauer JJ. High rates of metachronous colon cancer or dysplasia after segmental resection or subtotal colectomy in Crohn’s colitis. Inflamm Bowel Dis. 2013;19(9):1827–32.

    PubMed  Google Scholar 

  24. O’Riordan JM, O’Connor BI, Huang H, et al. Long-term outcome of colectomy and ileorectal anastomosis for Crohn’s colitis. Dis Colon Rectum. 2011;54(11):1347–54.

    Article  Google Scholar 

  25. Velayos F, Kathpalia P, Finlayson E. Changing paradigms in detection of dysplasia and management of patients with inflammatory bowel disease: is colectomy still necessary? Gastroenterology. 2017;152(2):440–50.e441

    Article  Google Scholar 

  26. Yamamoto T, Allan RN, Keighley MRB. Smoking is a predictive factor for outcome after colectomy and ileorectal anastomosis in patients with Crohn’s colitis. Br J Surg. 1999;86(8):1069–70.

    Article  CAS  Google Scholar 

  27. Toh JW. Surgery for colorectal cancer in Crohn’s disease: should we perform a total proctocolectomy for all patients with high-grade dysplasia and cancer in Crohn’s disease? Dis Colon Rectum. 2017;60(8):e605.

    Article  Google Scholar 

  28. Laine L, Kaltenbach T, Barkun A, McQuaid KR, Subramanian V, Soetikno R. SCENIC international consensus statement on surveillance and management of dysplasia in inflammatory bowel disease. Gastrointestinal Endosc. 2015;81(3):489–501.e426

    Article  Google Scholar 

  29. Lichtenstein GR, Loftus EV, Isaacs KL, Regueiro MD, Gerson LB, Sands BE. ACG clinical guideline: management of Crohn’s disease in adults. Am J Gastroenterol. 2018;113(4):481–517.

    Article  Google Scholar 

  30. Krugliak Cleveland N, Colman RJ, Rodriquez D, et al. Surveillance of IBD using high definition colonoscopes does not miss adenocarcinoma in patients with low-grade dysplasia. Inflamm Bowel Dis. 2016;22(3):631–7.

    Article  Google Scholar 

  31. Eluri S, Parian AM, Limketkai BN, et al. Nearly a third of high-grade dysplasia and colorectal cancer is undetected in patients with inflammatory bowel disease. Dig Dis Sci. 2017;62(12):3586–93.

    Article  Google Scholar 

  32. Kiran RP, Khoury W, Church JM, Lavery IC, Fazio VW, Remzi FH. Colorectal cancer complicating inflammatory bowel disease: similarities and differences between Crohn’s and ulcerative colitis based on three decades of experience. Ann Surg. 2010;252(2):330–5.

    Article  Google Scholar 

  33. Lightner AL. Segmental resection versus total proctocolectomy for Crohn’s colitis: what is the best operation in the setting of medically refractory disease or dysplasia? Inflamm Bowel Dis. 2018;24(3):532–8.

    Article  Google Scholar 

  34. Siegel CA, Schwartz LM, Woloshin S, et al. When should ulcerative colitis patients undergo colectomy for dysplasia? Mismatch between patient preferences and physician recommendations. Inflamm Bowel Dis. 2010;16(10):1658–62.

    Article  Google Scholar 

  35. Nieminen U, Jussila A, Nordling S, Mustonen H, Farkkila MA. Inflammation and disease duration have a cumulative effect on the risk of dysplasia and carcinoma in IBD: a case-control observational study based on registry data. Int J Cancer. 2014;134(1):189–96.

    Article  Google Scholar 

  36. Soetikno RM, Lin OS, Heidenreich PA, Young HS, Blackstone MO. Increased risk of colorectal neoplasia in patients with primary sclerosing cholangitis and ulcerative colitis: a meta-analysis. Gastrointest Endosc. 2002;56(1):48–54.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Colon & Rectal Surgery, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA

    Jeffrey S. Scow

  2. Division of Colon & Rectal Surgery, Mayo Clinic, Jacksonville, FL, USA

    Amit Merchea

Authors
  1. Jeffrey S. Scow
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amit Merchea
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amit Merchea .

Editor information

Editors and Affiliations

  1. Colon and Rectal Surgery, University of Chicago, Chicago, IL, USA

    Neil Hyman

  2. Section of Colon and Rectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Phillip Fleshner

  3. Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Scott Strong

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Scow, J.S., Merchea, A. (2019). Surgical Options for Neoplasia Complicating Crohn’s Disease of the Large Intestine. In: Hyman, N., Fleshner, P., Strong, S. (eds) Mastery of IBD Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-16755-4_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-16755-4_16

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-16754-7

  • Online ISBN: 978-3-030-16755-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation