Current Gastroenterology Reports

, Volume 14, Issue 2, pp 174–180

Managing Risks of Neoplasia in Inflammatory Bowel Disease

Inflammatory Bowel Disease (SB Hanauer, Section Editor)


Inflammatory bowel disease (IBD) has been linked with a variety of intestinal and extraintestinal cancers. This review summarizes the latest literature with regard to which cancers are truly linked with IBD and which are not, the absolute and relative risks of these cancers, how medications commonly prescribed for IBD affect this risk, and finally strategies for managing these risks. Physicians and health professionals may find this information useful for counseling and educating patients as well as for improving patient care.


Non-melanoma skin cancer Cervical cancer Cervical dysplasia Small bowel adenocarcinoma Colorectal cancer Lymphoma Thiopruine Anti-TNF 5-aminosalicylic acid 


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    • Peyrin-Biroulet L, Khosrotehrani K, Carrat F, et al. Increased risk for nonmelanoma skin cancers in patients who receive thiopurines for inflammatory bowel disease. Gastroenterology. 2011;141(5):1621–8. e1621-1625. Important prospective study establishing risk of non-melanoma skin cancer in people with inflammatory bowel disease on thiopruines.PubMedCrossRefGoogle Scholar
  2. 2.
    Long MD, Herfarth HH, Pipkin CA, Porter CQ, Sandler RS, Kappelman MD. Increased risk for non-melanoma skin cancer in patients with inflammatory bowel disease. Clin Gastroenterol Hepatol. 2010;8(3):268–74.PubMedCrossRefGoogle Scholar
  3. 3.
    Mellemkjaer L, Olsen JH, Frisch M, Johansen C, Gridley G, McLaughlin JK. Cancer in patients with ulcerative colitis. Int J Cancer. 1995;60(3):330–3.PubMedCrossRefGoogle Scholar
  4. 4.
    Ekbom A, Helmick C, Zack M, Adami HO. Extracolonic malignancies in inflammatory bowel disease. Cancer. 1991;67(7):2015–9.PubMedCrossRefGoogle Scholar
  5. 5.
    • Singh H, Nugent Z, Demers AA, Bernstein CN. Increased risk of nonmelanoma skin cancers among individuals with inflammatory bowel disease. Gastroenterology. Jul 30 2011. Important population-based study establishing risk of non-melanoma skin cancer in people with inflammatory bowel disease on thiopruines.Google Scholar
  6. 6.
    Singh H, Nugent Z, Demers AA, Bernstein CN. Increased risk of nonmelanoma skin cancers among individuals with inflammatory bowel disease. Gastroenterology. 2011;141(5):1612–20.PubMedCrossRefGoogle Scholar
  7. 7.
    Wolff T, Tai E, Miller T. Screening for skin cancer: an update of the evidence for the U.S. preventive. Rockville (MD); 2009.Google Scholar
  8. 8.
    Bhatia J, Bratcher J, Korelitz B, et al. Abnormalities of uterine cervix in women with inflammatory bowel disease. World J Gastroenterol. 2006;12(38):6167–71.PubMedGoogle Scholar
  9. 9.
    Kane S, Khatibi B, Reddy D. Higher incidence of abnormal Pap smears in women with inflammatory bowel disease. Am J Gastroenterol. 2008;103(3):631–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Singh H, Demers AA, Nugent Z, Mahmud SM, Kliewer EV, Bernstein CN. Risk of cervical abnormalities in women with inflammatory bowel disease: a population-based nested case–control study. Gastroenterology. 2009;136(2):451–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Lees CW, Critchley J, Chee N, et al. Lack of association between cervical dysplasia and IBD: a large case–control study. Inflamm Bowel Dis. 2009;15(11):1621–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Hutfless S, Fireman B, Kane S, Herrinton LJ. Screening differences and risk of cervical cancer in inflammatory bowel disease. Aliment Pharmacol Ther. 2008;28(5):598–605.PubMedCrossRefGoogle Scholar
  13. 13.
    Connell WR, Kamm MA, Dickson M, Balkwill AM, Ritchie JK, Lennard-Jones JE. Long-term neoplasia risk after azathioprine treatment in inflammatory bowel disease. Lancet. 1994;343(8908):1249–52.CrossRefGoogle Scholar
  14. 14.
    Nguyen GC, Frick KD, Dassopoulos T. Medical decision analysis for the management of unifocal, flat, low-grade dysplasia in ulcerative colitis. Gastrointest Endosc. 2009;69(7):1299–310.PubMedCrossRefGoogle Scholar
  15. 15.
    FDA licensure of quadrivalent human papillomavirus vaccine (HPV4, Gardasil) for use in males and guidance from the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. May 28 2010;59(20):630–32.Google Scholar
  16. 16.
    Shaukat A, Virnig DJ, Howard D, Sitaraman SV, Liff JM, Lederle FA. Crohn’s disease and small bowel adenocarcinoma: a population-based case–control study. Cancer Epidemiol Biomark Prev. 2011;20(6):1120–3.CrossRefGoogle Scholar
  17. 17.
    Jess T, Loftus Jr EV, Velayos FS, et al. Risk of intestinal cancer in inflammatory bowel disease: a population-based study from olmsted county, Minnesota. Gastroenterology. 2006;130(4):1039–46.PubMedCrossRefGoogle Scholar
  18. 18.
    Palascak-Juif V, Bouvier AM, Cosnes J, et al. Small bowel adenocarcinoma in patients with Crohn’s disease compared with small bowel adenocarcinoma de novo. Inflamm Bowel Dis. 2005;11(9):828–32.PubMedCrossRefGoogle Scholar
  19. 19.
    Piton G, Cosnes J, Monnet E, et al. Risk factors associated with small bowel adenocarcinoma in Crohn’s disease: a case–control study. Am J Gastroenterol. 2008;103(7):1730–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Soyer P, Hristova L, Boudghene F, et al. Small bowel adenocarcinoma in Crohn disease: CT-enterography features with pathological correlation. Abdom Imaging. Jun 14 2011.Google Scholar
  21. 21.
    Solem CA, Harmsen WS, Zinsmeister AR, Loftus Jr EV. Small intestinal adenocarcinoma in Crohn’s disease: a case–control study. Inflamm Bowel Dis. 2004;10(1):32–5.PubMedCrossRefGoogle Scholar
  22. 22.
    Rutter M, Saunders B, Wilkinson K, et al. Severity of inflammation is a risk factor for colorectal neoplasia in ulcerative colitis. Gastroenterology. 2004;126(2):451–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Jess T, Gamborg M, Matzen P, Munkholm P, Sorensen TI. Increased risk of intestinal cancer in Crohn’s disease: a meta-analysis of population-based cohort studies. Am J Gastroenterol. 2005;100(12):2724–9.PubMedCrossRefGoogle Scholar
  24. 24.
    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.PubMedCrossRefGoogle Scholar
  25. 25.
    Ekbom A, Helmick C, Zack M, Adami HO. Ulcerative colitis and colorectal cancer. A population-based study. N Engl J Med. 1990;323(18):1228–33.PubMedCrossRefGoogle Scholar
  26. 26.
    Eaden JA, Abrams KR, Mayberry JF. The risk of colorectal cancer in ulcerative colitis: a meta-analysis. Gut. 2001;48(4):526–35.PubMedCrossRefGoogle Scholar
  27. 27.
    Askling J, Dickman PW, Karlen P, et al. Family history as a risk factor for colorectal cancer in inflammatory bowel disease. Gastroenterology. 2001;120(6):1356–62.PubMedCrossRefGoogle Scholar
  28. 28.
    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.PubMedCrossRefGoogle Scholar
  29. 29.
    Rutter MD, Saunders BP, Wilkinson KH, et al. Cancer surveillance in longstanding ulcerative colitis: endoscopic appearances help predict cancer risk. Gut. 2004;53(12):1813–6.PubMedCrossRefGoogle Scholar
  30. 30.
    Velayos FS, Loftus Jr EV, Jess T, et al. Predictive and protective factors associated with colorectal cancer in ulcerative colitis: a case–control study. Gastroenterology. 2006;130(7):1941–9.PubMedCrossRefGoogle Scholar
  31. 31.
    •• Farraye FA, Odze RD, Eaden J, Itzkowitz SH. AGA technical review on the diagnosis and management of colorectal neoplasia in inflammatory bowel disease. Gastroenterology. 2010;138(2):746–74. 774 e741-744; quiz e712-743. Important comprehensive review regarding colorectal cancer detection and prevention in inflammatory bowel disease.PubMedCrossRefGoogle Scholar
  32. 32.
    Allgayer H. Review article: mechanisms of action of mesalazine in preventing colorectal carcinoma in inflammatory bowel disease. Aliment Pharmacol Ther. 2003;18 Suppl 2:10–4.PubMedCrossRefGoogle Scholar
  33. 33.
    Velayos FS, Terdiman JP, Walsh JM. Effect of 5-aminosalicylate use on colorectal cancer and dysplasia risk: a systematic review and metaanalysis of observational studies. Am J Gastroenterol. 2005;100(6):1345–53.PubMedCrossRefGoogle Scholar
  34. 34.
    Siegel CA, Sands BE. Risk factors for colorectal cancer in Crohn’s colitis: a case–control study. Inflamm Bowel Dis. 2006;12(6):491–6.PubMedCrossRefGoogle Scholar
  35. 35.
    Rubin DT, Lashner BA. Will a 5-ASA a day keep the cancer (and dysplasia) away? Am J Gastroenterol. 2005;100(6):1354–6.PubMedCrossRefGoogle Scholar
  36. 36.
    Kornbluth A, Sachar DB. Ulcerative colitis practice guidelines in adults (update): American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol. 2004;99(7):1371–85.PubMedCrossRefGoogle Scholar
  37. 37.
    Davila RE, Rajan E, Baron TH, et al. ASGE guideline: colorectal cancer screening and surveillance. Gastrointest Endosc. 2006;63(4):546–57.PubMedCrossRefGoogle Scholar
  38. 38.
    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.PubMedCrossRefGoogle Scholar
  39. 39.
    Winawer S, Fletcher R, Rex D, et al. Colorectal cancer screening and surveillance: clinical guidelines and rationale-Update based on new evidence. Gastroenterology. 2003;124(2):544–60.PubMedCrossRefGoogle Scholar
  40. 40.
    Itzkowitz SH, Present DH. Consensus conference: Colorectal cancer screening and surveillance in inflammatory bowel disease. Inflamm Bowel Dis. 2005;11(3):314–21.PubMedCrossRefGoogle Scholar
  41. 41.
    Rutter MD, Saunders BP, Wilkinson KH, Kamm MA, Williams CB, Forbes A. Most dysplasia in ulcerative colitis is visible at colonoscopy. Gastrointest Endosc. 2004;60(3):334–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Marion JF, Waye JD, Present DH, et al. Chromoendoscopy-targeted biopsies are superior to standard colonoscopic surveillance for detecting dysplasia in inflammatory bowel disease patients: a prospective endoscopic trial. Am J Gastroenterol. 2008;103(9):2342–9.PubMedCrossRefGoogle Scholar
  43. 43.
    Rutter MD, Saunders BP, Schofield G, Forbes A, Price AB, Talbot IC. Pancolonic indigo carmine dye spraying for the detection of dysplasia in ulcerative colitis. Gut. 2004;53(2):256–60.PubMedCrossRefGoogle Scholar
  44. 44.
    Dekker E, van den Broek FJ, Reitsma JB, et al. Narrow-band imaging compared with conventional colonoscopy for the detection of dysplasia in patients with longstanding ulcerative colitis. Endoscopy. 2007;39(3):216–21.PubMedCrossRefGoogle Scholar
  45. 45.
    Beaugerie L, Brousse N, Bouvier AM, et al. Excess risk of lymphoproliferative disorders (LPD) in inflammatory bowel diseases (IBD): interim results of the CESAME cohort. Gastroenterology. 2008;134(A):116–7.Google Scholar
  46. 46.
    Lewis JD, Bilker WB, Brensinger C, Deren JJ, Vaughn DJ, Strom BL. Inflammatory bowel disease is not associated with an increased risk of lymphoma. Gastroenterology. 2001;121(5):1080–7.PubMedCrossRefGoogle Scholar
  47. 47.
    Loftus Jr EV, Tremaine WJ, Habermann TM, Harmsen WS, Zinsmeister AR, Sandborn WJ. Risk of lymphoma in inflammatory bowel disease. Am J Gastroenterol. 2000;95(9):2308–12.PubMedCrossRefGoogle Scholar
  48. 48.
    Mir-Madjlessi SH, Farmer RG, Easley KA, Beck GJ. Colorectal and extracolonic malignancy in ulcerative colitis. Cancer. 1986;58(7):1569–74.PubMedCrossRefGoogle Scholar
  49. 49.
  50. 50.
    Kandiel A, Fraser AG, Korelitz BI, Brensinger C, Lewis JD. Increased risk of lymphoma among inflammatory bowel disease patients treated with azathioprine and 6-mercaptopurine. Gut. 2005;54(8):1121–5.PubMedCrossRefGoogle Scholar
  51. 51.
    • Beaugerie L, Brousse N, Bouvier AM, et al. Lymphoproliferative disorders in patients receiving thiopurines for inflammatory bowel disease: a prospective observational cohort study. Lancet. 2009;374(9701):1617–25. Important population-based study establishing the risk of lymphoma in thiopruine users.PubMedCrossRefGoogle Scholar
  52. 52.
    Siegel CA, Marden SM, Persing SM, Larson RJ, Sands BE. Risk of lymphoma associated with combination anti-tumor necrosis factor and immunomodulator therapy for the treatment of Crohn’s disease: a meta-analysis. Clin Gastroenterol Hepatol. 2009;7(8):874–81.PubMedCrossRefGoogle Scholar
  53. 53.
    Kotlyar DS, Osterman MT, Diamond RH, et al. A systematic review of factors that contribute to hepatosplenic T-cell lymphoma in patients with inflammatory bowel disease. Clin Gastroenterol Hepatol. 2011;9(1):36–41. e31.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.University of California, San Francisco, Center for Crohn’s and ColitisSan FranciscoUSA

Personalised recommendations