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The Cancer “Fear” in IBD Patients: Is It Still REAL?

  • Evidence-Based Current Surgical Practice
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Increased rates of colorectal cancer (CRC) with high rates of progression from dysplasia to CRC are well documented in the inflammatory bowel disease (IBD) population. This increased risk in the presence of currently improving but still inadequate surveillance techniques confirms that the cancer “fear” in IBD patients is still real. The majority of data on the cancer risk in IBD has been gathered from ulcerative colitis (UC) patients as these patients are generally better studied. Thus surveillance and treatment protocols for Crohn’s disease (CD) are frequently modeled on UC paradigms. Dysplasia in the IBD cohort frequently is a harbinger of local, distant, or metachronous neoplasia. Therefore, frequent surveillance and referral for surgical intervention when dysplasia is detected are justified in both the CD and UC patient.

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Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Hershey Medical Center, Penn State College of Medicine, Hershey, PA, 17033, USA

    T. M. Connelly & W. A. Koltun

Authors
  1. T. M. Connelly
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  2. W. A. Koltun
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Corresponding author

Correspondence to W. A. Koltun.

Additional information

MCQs

1. The only surgical resection that will excise all primary and synchronous neoplasms and prevent metachronous lesions in IBD is:

A) Total proctocolectomy

B) Total abdominal Colectomy

C) Segmental resection of the affected colon

D) None of the above

2. DALM is:

A) Dysplasia-associated lesion or mass that is readily amenable to colonoscopic removal

B) Dysplasia/adenoma luminal material that is used in chromoendoscopy to improve identification of lesions in ulcerative colitis patients

C) Dysplasia-associated lesion or mass that by definition is unable to be removed colonoscopically and mandates surgical excision

D) Dysplasia/adenoma luminal mass that frequently is diagnosed as a hyperplastic polyp on biopsy and pathology

3. Multifocal flat high-grade dysplasia discovered on surveillance colonoscopy in an otherwise healthy UC patient, suggests the need for which of the following:

A) Repeat colonoscopy/multiple every 10 cm biopsies in 6–12 months

B) Total proctocolectomy

C) Institution of ASA derivatives and repeat colonoscopy/biopsies in 6–12 months

D) Diverting ileostomy to quell inflammation and repeat colonoscopy/biopsies.

4. A 40-year-old male patient presents with a 20-year history of colitis and low-grade dysplasia on colonoscopy. The next step in diagnosis and treatment is:

A) Confirmation by second pathologist opinion and/or repeat biopsy

B) Endoscopic resection of all dysplasia

C) Repeat colonoscopy in 6 months

D) Segmental resection of all areas containing dysplasia

5. A colonic stricture in a UC patient is a concern for:

A) Impending obstruction

B) Crohn's disease

C) Carcinoma

D) All of the above

6. A large polypoid mass is discovered in an area of inflammation in a Crohn's patient. This lesion is called:

A) Low-grade dysplasia

B) A DALM

C) An ALM

D) An adenoma-like DALM

7. Risk factors for CRC in the IBD patient include:

A) PSC

B) Family history of colorectal cancer

C) Extensive colitis

D) All of the above

8. Cumulative risk of CRC in UC 30 years after diagnosis is:

A) 5 %

B) Equal to the non IBD population

C) 18 %

D) 10 %

Answers:

1) A

2) C

3) B

4) A

5) D

6) D

7) D

8) C

The Division of Colon and Rectal Surgery at Penn State College of Medicine, Hershey Penn State Medical Center is the recipient of the Carlino Fund for IBD Research

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Connelly, T.M., Koltun, W.A. The Cancer “Fear” in IBD Patients: Is It Still REAL?. J Gastrointest Surg 18, 213–218 (2014). https://doi.org/10.1007/s11605-013-2317-z

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  • DOI: https://doi.org/10.1007/s11605-013-2317-z

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