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Colorectal Cancer and Crohn’s Colitis: Clinical Implications From 313 Surgical Patients

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Abstract

Background

The relation between Crohn’s colitis (CC) and colorectal cancer is still controversial. Several case reports and retrospective studies have shown that patients with Crohn’s disease (CD) have a 6- to 20-fold higher risk to develop CRC than does the normal population. The extent of disease (extensive colitis), presence of anal fistula, age > 40 years, strictures, and length of disease >10 years may be important determinants for increasing risk. Despite this evidence, other population-based studies have shown no increased risk of colon or rectal cancer. The aim of this study was to investigate retrospectively factors that may predict the development of cancer.

Methods

We searched the histopathologic database of the Digestive Surgery Unit at Careggi University Hospital for CC patients (January 1987 to September 2011) and identified 313 patients with CC who underwent surgery.

Results

There are 11 (3.5 %) of adenocarcinomas. Multivariate analysis showed disease duration (p = 0.001), age at CD diagnosis (p = 0.002), distal localization (p = 0.045), and penetrating disease (p = 0.041) to be risk factors. Multivariate analysis showed that 40 patients who had undergone previous immunosuppressive therapy had a significant risk of developing CRC (p = 0.026).

Conclusions

Crohn’s colitis patients who require surgery are at higher risk for developing CRC, particularly those whose disease duration is >10 years, have distal localization, age at diagnosis was <40 years, and have penetrating disease. Previous immunosuppressive therapy should be better investigated. We recommend surgery for any patient presenting with colonic strictures.

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References

  1. Brostrom O, Lofberg R, Nordenvall B et al (1987) The risk of colorectal cancer in ulcerative colitis: an epidemiologic study. Scand J Gastroenterol 22:1193–1199

    Article  PubMed  CAS  Google Scholar 

  2. Dawson IM, Pryse-Davies J (1959) The development of carcinoma of the large intestine in ulcerative colitis. Br J Surg 47:113–128

    Article  PubMed  CAS  Google Scholar 

  3. Eaden JA, Abrams KR, Mayberry JF (2001) The risk of colorectal cancer in ulcerative colitis: a meta-analysis. Gut 48:526–535

    Article  PubMed  CAS  Google Scholar 

  4. Gyde SN, Prior P, Allan RN et al (1988) Colorectal cancer in ulcerative colitis: a cohort study of primary referrals from three centres. Gut 29:206–217

    Article  PubMed  CAS  Google Scholar 

  5. Lashner BA, Silverstein MD, Hanauer SB (1989) Hazard rates for dysplasia and cancer in ulcerative colitis: results from a surveillance program. Dig Dis Sci 34:1536–1541

    Article  PubMed  CAS  Google Scholar 

  6. Lennard-Jones JE, Melville DM, Morson BC et al (1990) Precancer and cancer in extensive ulcerative colitis: findings among 401 patients over 22 years. Gut 31:800–806

    Article  PubMed  CAS  Google Scholar 

  7. Lindberg B, Persson B, Veress B et al (1996) Twenty years’ colonoscopic surveillance of patients with ulcerative colitis: detection of dysplastic and malignant transformation. Scand J Gastroenterol 31:1195–1204

    Article  PubMed  CAS  Google Scholar 

  8. Maratka Z, Nedbal J, Kocianova J et al (1985) Incidence of colorectal cancer in proctocolitis: a retrospective study of 959 cases over 40 years. Gut 26:43–49

    Article  PubMed  CAS  Google Scholar 

  9. Sachar DB, Greenstein AJ (1981) Cancer in ulcerative colitis: good news and bad news. Ann Intern Med 95:642–644

    PubMed  CAS  Google Scholar 

  10. Bernstein D, Rogers A (1996) Malignancy in Crohn’s disease. Am J Gastroenterol 91:434–440

    PubMed  CAS  Google Scholar 

  11. Connell WR, Sheffield JP, Kamm MA et al (1994) Lower gastrointestinal malignancy in Crohn’s disease. Gut 35:347–352

    Article  PubMed  CAS  Google Scholar 

  12. Ekbom A, Helmick C, Zack M et al (1990) Increased risk of large-bowel cancer in Crohn’s disease with colonic involvement. Lancet 336:349–357

    Article  Google Scholar 

  13. Gillen CD, Walmsley RS, Prior P et al (1994) Ulcerative colitis and Crohn’s disease: a comparison of the colorectal cancer risk in extensive colitis. Gut 35:1590–1592

    Article  PubMed  CAS  Google Scholar 

  14. Maykel JA, Hagerman G, Mellgren AF et al (2006) Crohn’s colitis: the incidence of dysplasia and adenocarcinoma in surgical patients. Dis Colon Rectum 49:950–957

    Article  PubMed  Google Scholar 

  15. Michelassi F, Testa G, Pomidor WJ et al (1993) Adenocarcinoma complicating Crohn’s disease. Dis Colon Rectum 36:654–661

    Article  PubMed  CAS  Google Scholar 

  16. Weedon DD, Shorter RG, Ilstrup DM et al (1973) Crohn’s disease and cancer. N Engl J Med 289:1099–1103

    Article  PubMed  CAS  Google Scholar 

  17. Bernstein CN, Blanchard JF, Kliewer E et al (2001) Cancer risk in patients with inflammatory bowel disease: a population-based study. Cancer 91:854–862

    Article  PubMed  CAS  Google Scholar 

  18. Binder V, Hendriksen C, Kreiner S (1985) Prognosis in Crohn’s disease based on results from a regional patient group from the county of Copenhagen. Gut 26:146–150

    Article  PubMed  CAS  Google Scholar 

  19. Gollop JH, Phillips SF, Melton LJ III et al (1988) Epidemiologic aspects of Crohn’s disease: a population based study in Olmsted County, Minnesota, 1943–1982. Gut 29:49–56

    Article  PubMed  CAS  Google Scholar 

  20. Persson PG, Karlen P, Bernell O et al (1994) Crohn’s disease and cancer: a population-based cohort study. Gastroenterology 107:1675–1679

    PubMed  CAS  Google Scholar 

  21. Collins PD, Mpofu C, Watson AJ, et al (2006) Strategies for detecting colon cancer and/or dysplasia in patients with inflammatory bowel disease. Cochrane Database Syst Rev (2):CD000279

  22. Fireman Z, Grossman A, Lilos P et al (1989) Intestinal cancer in patients with Crohn’s disease: a population study in central Israel. Scand J Gastroenterol 24:346–350

    Article  PubMed  CAS  Google Scholar 

  23. Jess T, Gamborg M, Matzen P et al (2005) Increased risk of intestinal cancer in Crohn’s disease: a meta-analysis of population-based cohort studies. Am J Gastroenterol 100:2724–2729

    Article  PubMed  Google Scholar 

  24. de Ponz LM, Marino M, Benatti P et al (2004) Trend of incidence, subsite distribution and staging of colorectal neoplasms in the 15-year experience of a specialised cancer registry. Ann Oncol 15:940–946

    Article  Google Scholar 

  25. Beaugerie L, Brousse N, Bouvier AM et al (2009) Lymphoproliferative disorders in patients receiving thiopurines for inflammatory bowel disease: a prospective observational cohort study. Lancet 374:1617–1625

    Article  PubMed  CAS  Google Scholar 

  26. Biancone L, Orlando A, Kohn A et al (2006) Infliximab and newly diagnosed neoplasia in Crohn’s disease: a multicentre matched pair study. Gut 55:228–233

    Article  PubMed  CAS  Google Scholar 

  27. Biancone L, Petruzziello C, Orlando A et al (2011) Cancer in Crohn’s Disease patients treated with infliximab: a long-term multicenter matched pair study. Inflamm Bowel Dis 17:758–766

    Article  PubMed  Google Scholar 

  28. Mackey AC, Green L, Liang LC et al (2007) Hepatosplenic T cell lymphoma associated with infliximab use in young patients treated for inflammatory bowel disease. J Pediatr Gastroenterol Nutr 44:265–267

    Article  PubMed  Google Scholar 

  29. Shale M, Kanfer E, Panaccione R et al (2008) Hepatosplenic T cell lymphoma in inflammatory bowel disease. Gut 57:1639–1641

    Article  PubMed  Google Scholar 

  30. Van Schaik FD, van Oijen MG, Smeets HM et al (2012) Thiopurines prevent advanced colorectal neoplasia in patients with inflammatory bowel disease. Gut 61:235–240

    Article  PubMed  Google Scholar 

  31. Kiesslich R, Neurath MF (2004) Surveillance colonoscopy in ulcerative colitis: magnifying chromoendoscopy in the spotlight. Gut 53:165–167

    Article  PubMed  CAS  Google Scholar 

  32. Kiesslich R, Goetz M, Lammersdorf K et al (2007) Chromoscopy-guided endomicroscopy increases the diagnostic yield of intraepithelial neoplasia in ulcerative colitis. Gastroenterology 132:874–882

    Article  PubMed  Google Scholar 

  33. Hurlstone DP, McAlindon ME, Sanders DS et al (2004) Further validation of high-magnification chromoscopic-colonoscopy for the detection of intraepithelial neoplasia and colon cancer in ulcerative colitis. Gastroenterology 126:376–378

    Article  PubMed  Google Scholar 

  34. Ullman TA (2007) Chromoendoscopy should be the standard method and more widely used for cancer surveillance colonoscopy in ulcerative colitis. Inflamm Bowel Dis 13:1273–1274

    Article  PubMed  Google Scholar 

  35. Kuiper T, van den Broek FJ, van Eeden S et al (2012) Feasibility and accuracy of confocal endomicroscopy in comparison with narrow-band imaging and chromoendoscopy for the differentiation of colorectal lesions. Am J Gastroenterol 107:543–550

    Article  PubMed  CAS  Google Scholar 

  36. Lansdorp-Vogelaar I, Kuntz KM, Knudsen AB et al (2010) Stool DNA testing to screen for colorectal cancer in the Medicare population: a cost-effectiveness analysis. Ann Intern Med 153:368–377

    PubMed  Google Scholar 

  37. Osborn NK, Ahlquist DA (2005) Stool screening for colorectal cancer: molecular approaches. Gastroenterology 128:192–206

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

Thanks go to the Association of Italian Cancer Registries (AIRTUM), and particularly to Dr. Emanuele Crocetti for providing data of colorectal cancer incidence and survival in general population. In memory of Professor Andrea Tropea, surgeon and friend.

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Authors and Affiliations

  1. Digestive Surgery Unit, Careggi University Hospital, Largo Brambilla 2, 50134, Florence, Italy

    Stefano Scaringi, Carmela Di Martino, Daniela Zambonin, Marilena Fazi, Giuseppe Canonico, Francesca Leo, Ferdinando Ficari & Francesco Tonelli

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  1. Stefano Scaringi
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  2. Carmela Di Martino
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  3. Daniela Zambonin
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  4. Marilena Fazi
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  5. Giuseppe Canonico
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  7. Ferdinando Ficari
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  8. Francesco Tonelli
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Correspondence to Stefano Scaringi.

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Scaringi, S., Di Martino, C., Zambonin, D. et al. Colorectal Cancer and Crohn’s Colitis: Clinical Implications From 313 Surgical Patients. World J Surg 37, 902–910 (2013). https://doi.org/10.1007/s00268-013-1922-z

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