Abstract
The success or failure of a surveillance programme in colitis must be judged by its effect on mortality from colorectal carcinoma. The object of surveillance is to reduce the mortality among those patients for whom surgical treatment does not appear indicated for other reasons. Published evidence suggests that the cumulative mortality among patients with extensive colitis who survive with an intact colon 25 years from onset of their colitis is about 8%. This mortality appears great enough to justify the possible dangers, discomfort and cost of a surveillance programme with a reasonable expectation of success. The techniques of surveillance aim to detect an undoubted pre-cancerous phase or, failing that, carcinoma which has not spread outside the bowel wall. Evidence for benefit of surveillance is at present indirect and based on the mortality among patients who cease follow-up and the pathological stage of carcinoma at the time of colectomy.
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References
Nicholls, R.J. and Pezim, M,E.(1985) Restorative proctocolectomy with ileal reservoir for ulcerative colitis and familial adenomatous polyposis: a comparison of three reservoir designs. Br.J.Surg. 72, 470–4.
Phillips, R.K.S., Ritchie, J.K. and Hawley, P.R. (1989) Proctocolectomy and ileostomy for ulcerative colitis: the longer term story. J.Roy.Soc.Med. 82, 386–7.
Gyde, S.N., Prior, P., Allan, R.N., Stevens, A., Jewell, D.P., Truelove, S.C., Lofberg, R., Brostrom, O. and Hellers, G. (1988) Gut 29, 206–17.
Katzka, I., Brody, R.S., Morris, E. and Katz, S. (1983) Assessment of colorectal cancer risk in patients with ulcerative colitis: experience from a private practice. Gastroenterology 85, 22–9.
Brostrom, O., Lofberg, R., Nordenvall, B., Ost, A. and Hellers, G. The risk of colorectal cancer in ulcerative colitis. Scand. J. Gastroenterol. 22, 1193–9.
Lennard-Jones, J.E., Melville, D.M., Morson, B.C., Ritchie, J.K. and Williams, C.B. (1989) Precancer and cancer in extensive ulcerative colitis: findings among 401 patients over 22 years. Gut 30, in press.
Hughes, R.G., Hall, T.J., Block, G.E., Levin, B. and Moossa, A.R. (1978) The prognosis of carcinoma of the colon and rectum complicating ulcerative colitis. Surg.Gynec.Obstet. 146, 46–8.
van Heerden, J.A. and Beart, R.W. (1980) Carcinoma of the colon and rectum complicating chronic ulcerative colitis. Dis.Colon Rectum. 23, 155–9.
Ritchie, J.K., Hawley, P.R. and Lennard-Jones, J.E. (1981) Prognosis of carcinoma in ulcerative colitis. Gut 22, 752–5.
Lavery, I.C., Chiulli, R.A., Jagelman, D.J., Fazio, V.W. and Weakley, F.L. (1982) Survival with carcinoma arising in mucosal ulcerative colitis. Ann.Surg. 195, 508–12.
Ohman, U. (1982) Colorectal carcinoma in patients with ulcerative colitis. Amer.J.Surg. 144, 344–9.
Johnson, W.R., McDermott, F.T., Hughes, E.S.R., Pihl, E.A., Milne, B.J. and Price, A.B. (1983) Carcinoma of the colon and rectum in inflammatory disease of the intestine. Surg.Gynec.Obstet. 156, 193–7.
Gyde, S.N., Prior, P., Thompson, H., Waterhouse, J.A.H. and Allan, R.N. (1984) Survival of patients with colorectal cancer complicating ulcerative colitis. Gut 25, 228–31.
Mir-Madjlessi, S.H., Farmer, R., Easley, K.A. and Beck G.J. (1986) Colorectal and extracolonic malignancy in ulcerative colitis. Cancer 58, 1569–74.
Marteau, T.M. (1989) Psychological costs of screening. Brit.med.J. 299, 527.
Jones, H.W., Grogono, J. and Hoare, A.M. (1988) Surveillance in ulcerative colitis: burdens and benefit. Gut 29, 325–31.
Collins, R.H., Feldman, M. and Fordtran, J.S. (1987) Colon cancer, dysplasia, and surveillance in patients with ulcerative colitis: a critical review. N.Engl.J.Med. 316, 1654–8.
Melville, D.M., Jass, J.R., Morson, B.C., Pollock, D.J., Richman, P.I, Shepherd, N.A., Ritchie, J.K., Love, S.B. and Lennard-Jones, J.E. (1989) Observer study on the grading of dysplasia in ulcerative colitis: comparison with clinical outcome. Hum.Path. in press.
Granqvist, S., Gabrielsson, N., Sundelin, P. and Thorgeirsson, T. (1980) Precancerous lesions in the mucosa in ulcerative colitis: a radiographic, endoscopic, and histopathologic study. Scand. J. Gastroenterol. 15, 289–96.
Brostrom, O., Lofberg, R., Ost, A. and Reichard, H. (1986) Cancer surveillance of patients with longstanding ulcerative colitis: a clinical, endoscopical, and histological study. Gut 27, 1408–13.
Manning, A.P., Bulgim, O.R., Dixon, M.F. and Axon, A.T.R. (1987) Screening by colonoscopy for colonic epithelial dysplasia in inflammatory bowel disease. Gut 28, 1489–94.
Rutegard, J., Ahsgren, L., Stenling, R. and Janunger, K.G. (1988) Ulcerative colitis: cancer surveillance in an unselected population. Scand. J. Gastroenterol. 23, 139–45.
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Lennard-Jones, J.E. (1990). Is There Any Benefit from Cancer Surveillance in Ulcerative Colitis?. In: Rachmilewitz, D., Zimmerman, J. (eds) Inflammatory Bowel Diseases 1990. Developments in Gastroenterology, vol 11. Springer, Dordrecht. https://doi.org/10.1007/978-94-009-1980-8_12
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DOI: https://doi.org/10.1007/978-94-009-1980-8_12
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