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Clinical Presentation and Diagnosis of Intestinal Adenocarcinoma in Crohn’s Disease: Analysis of Clinical Predictors and of the Life-Time Risk

  • 2010 SSAT Poster Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Late diagnosis of cancer in CD often occurs, and the prognosis is poor. The primary aim of this study was to assess the relationship between clinical presentation and diagnosis of intestinal adenocarcinoma in CD; the secondary aim was to evaluate the timing of cancer occurrence in CD patients.

Patients and methods

Medical records of 12 consecutive patients with intestinal adenocarcinoma in CD and of 79 consecutive CD patients undergoing bowel surgery were reviewed. Presentation symptoms were analyzed as possible predictors. Timing of intestinal adenocarcinoma occurrence in patients with CD was analyzed including all the 347 consecutive patients that had undergone surgery for CD in our institute from January 1984 to June 2008. Life table analysis and uni/multivariate analyses were performed.

Results

Ten men and two women underwent surgery for intestinal cancer in CD with a median age of 50 years (31–68). Carcinomas were localized in the terminal ileum in four cases, right colon in three, transverse colon in one, sigmoid colon in one, rectum in two, and an anorectal fistula in one. Only three patients were pre-operatively diagnosed with cancer. At multivariate analysis only age (OR 1.057 (95% CI 0.999–1.107), p = 0.05) and obstruction (OR 6.530 (95% CI 1.533–27.806), p = 0.01) significantly predicted cancer diagnosis. The risk rate (RR) for cancer occurrence started to rise at the end of the third decade of life (RR = 0.005). The analysis of risk rate for cancer occurrence during overt CD showed that it is initially high at onset (RR = 0.001) and after two other peaks at 150 months from onset, it began to rise again. The presence of Crohn’s colitis was associated to a significant risk of cancer (HR = 4.790, p = 0.009) while the use of 5-ASA resulted to be a protective factor against cancer occurrence (HR = 0.122, p = 0.013).

Discussion

In CD, rectal bleeding, the most common alarm symptom for intestinal cancer, is not useful for an early diagnosis. CD patients presenting with an older age and obstruction should be thoroughly investigated to rule out neoplastic lesions. There is probably no safe interval of CD where surveillance for intestinal cancer can be omitted. In the meantime, even in absence of active disease, all CD patients should undergo therapy with 5-ASA.

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References

  1. Friedman S. Cancer in Crohn's disease. Gastroenterol Clin North Am. 2006;35:621–639.

    Article  PubMed  Google Scholar 

  2. Ekbom A, Helmick C, Zack M, Adami HO. Increased risk of large-bowel cancer in Crohn’s disease with colonic involvement. Lancet 1990;336:357–359.

    Article  CAS  PubMed  Google Scholar 

  3. Bernstein CN, Blanchard JF, Kliewer E, Wajda A. Cancer risk in patients with inflammatory bowel disease: a population based study. Cancer 2001;91:854–862.

    Article  CAS  PubMed  Google Scholar 

  4. Jess T, Gamborg M, Matzen P, Munkholm P, Sørensen TI. Increased risk of intestinal cancer in Crohn’s disease: a meta-analysis of population- based cohort studies. Am J Gastroenterol 2005;100:2724–2729.

    Article  PubMed  Google Scholar 

  5. Maykel JA, Hagerman G, Mellgren AF, Li SY, Alavi K, Baxter NN, Madoff RD. Crohn's colitis: the incidence of dysplasia and adenocarcinoma in surgical patients. Dis Colon Rectum. 2006;49:950–957.

    Article  PubMed  Google Scholar 

  6. Freeman HJ. Colorectal cancer complicating Crohn’s disease. Can J Gastroenterol 2001;15:231–236.

    CAS  PubMed  Google Scholar 

  7. Xie J, Itzkowitz SH. Cancer in inflammatory bowel disease. World J Gastroenterol. 2008;14:378–389.

    Article  CAS  PubMed  Google Scholar 

  8. Kersting S, Bruewer M, Laukoetter MG, Rijcken EM, Mennigen R, Buerger H, Senninger N, Krieglstein CF. Intestinal cancer in patients with Crohn's disease. Int J Colorectal Dis. 2007;22:411–417.

    Article  PubMed  Google Scholar 

  9. Rubio CA, Befrits R Colorectal cancer in Crohn's disease--review of a 56-year experience in Karolinska Institute University Hospital. J Environ Pathol Toxicol Oncol. 2008;27:257–266.

    PubMed  Google Scholar 

  10. Rubio CA, Kapraali M, Befrits R. Further studies on the frequency of colorectal cancer in Crohn's colitis: an 11-year survey in the Northwest Stockholm County. Anticancer Res. 2009;29:4291-4295-

    Google Scholar 

  11. Bernstein CN. How do we assess the value of surveillance techniques in ulcerative colitis? J Gastrointest Surg 1998;2:318–321.

    Article  CAS  PubMed  Google Scholar 

  12. 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;6:993–998.

    Article  PubMed  Google Scholar 

  13. Strong SA, Koltun WA, Hyman NH, Buie WD; Standards Practice Task Force of The American Society of Colon and Rectal Surgeons Practice parameters for the surgical management of Crohn's disease. Dis Colon Rectum. 2007;50:1735–1746.

    Article  PubMed  Google Scholar 

  14. Choi PM, Zelig MP. Similarity of colorectal cancer in Crohn's disease and ulcerative colitis: implications for carcinogenesis and prevention. Gut. 1994;35:950–954.

    Article  CAS  PubMed  Google Scholar 

  15. Greenstein AJ, Sachar DB, Smith H, Janowitz HD, Aufses AH Jr. A comparison of cancer risk in Crohn’s disease and ulcerative colitis. Cancer 1981;48:2742–2745.

    Article  CAS  PubMed  Google Scholar 

  16. Gillen CD, Andrews HA, Prior P, Allan RN. Crohn’s disease and colorectal cancer. Gut 1994;35(5):651–5.

    Article  CAS  PubMed  Google Scholar 

  17. van Staa TP, Card T, Logan RF, Leufkens HG. 5-Aminosalicylate use and colorectal cancer risk in inflammatory bowel disease: a large epidemiological study. Gut 2005;54:1573–1578.

    Article  PubMed  Google Scholar 

  18. 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;100:1345–1353.

    Article  CAS  PubMed  Google Scholar 

  19. Freeman HJ. What is the cancer risk in Crohn’s disease? Inflamm Bowel Dis 2008; 14 (S2): S63–64.

    Google Scholar 

  20. D'Incà R, Cardin R, Benazzato L, Angriman I, Martines D, Sturniolo GC. Oxidative DNA damage in the mucosa of ulcerative colitis increases with disease duration and dysplasia. Inflamm Bowel Dis. 2004;10:23–27.

    Article  PubMed  Google Scholar 

  21. Brackmann S, Andersen SN, Aamodt G, Langmark F, Clausen OP, Aadland E, Fausa O, Rydning A, Vatn MH. Relationship between clinical parameters and the colitis-colorectal cancer interval in a cohort of patients with colorectal cancer in inflammatory bowel disease. Scand J Gastroenterol. 2009;44:46–55.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. II Department of Surgery (IV Unit), Regional Hospital “Cà Foncello”, Treviso, Italy

    Cesare Ruffolo & Nicolò Bassi

  2. Department of Oncological Surgery, Veneto Oncological Institute (IOV-IRCCS), Padova, Italy

    Marco Scarpa

  3. Department of Surgical and Gastroenterological Sciences, University of Padova, Padova, Italy

    Lino Polese, Francesco E. D’Amico, Riccardo Boetto, Anna Pozza, Renata D’Incà, Davide Checchin, Giacomo Carlo Sturniolo & Imerio Angriman

  4. IV Unit of Surgery, Regional Hospital Cà Foncello, Piazza Ospedale 1, 31100, Treviso, Italy

    Cesare Ruffolo

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  1. Cesare Ruffolo
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  2. Marco Scarpa
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  3. Lino Polese
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  4. Francesco E. D’Amico
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  6. Anna Pozza
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  9. Giacomo Carlo Sturniolo
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  10. Nicolò Bassi
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Corresponding author

Correspondence to Cesare Ruffolo.

Additional information

In memory of Prof. Attilio Cecchetto

Cesare Ruffolo and Marco Scarpa equally contributed to this paper

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Ruffolo, C., Scarpa, M., Polese, L. et al. Clinical Presentation and Diagnosis of Intestinal Adenocarcinoma in Crohn’s Disease: Analysis of Clinical Predictors and of the Life-Time Risk. J Gastrointest Surg 14, 1746–1751 (2010). https://doi.org/10.1007/s11605-010-1265-0

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  • DOI: https://doi.org/10.1007/s11605-010-1265-0

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