Nearly a Third of High-Grade Dysplasia and Colorectal Cancer Is Undetected in Patients with Inflammatory Bowel Disease

Eluri, Swathi; Parian, Alyssa; Limketkai, Berkeley N.; Ha, Christina; Brant, Steven R.; Dudley-Brown, Sharon; Efron, Jonathan E.; Fang, Sandy G.; Gearhart, Susan L.; Marohn, Michael R.; Meltzer, Stephen J.; Safar, Bashar; Truta, Brindusa; Montgomery, Elizabeth A.; Lazarev, Mark

doi:10.1007/s10620-017-4652-5

Cited by 25 publications

(16 citation statements)

References 20 publications

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“…Patients with long-standing ulcerative colitis (UC) and Crohn's disease (CD) are at a higher risk of developing CRC compared to the general population. 5 Although IBD-associated CRC accounts for approximately 2% of all CRC, the rate of death resulting from CRC in IBD patients ranges from 10 to 15%. 6 he incidence rate corresponded to a cumulative probability of 2% by 10years; 8% by 20 years; and 18% by 30years.…”

Section: Discussionmentioning

confidence: 99%

Crohn's disease discovered by colon adenocarcinoma

Boudabous¹,

Yasmine²,

Ayadi³

et al. 2020

GHOA

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Colorectal cancer (CRC) is the third most common malignancy and fourth leading cause of cancer-related mortality worldwide. 1,2 Inflammatory bowel disease (IBD) is widely accepted as one of the important risk factors leading to colorectal cancer (CRC). IBD ranks as the third highest risk condition for CRC. 3 In this group of patients the incidence of CRC increases by 60% compared to that of the general population. 4 However; it is unusual to discover Crohn's disease after the development of cancer. We present a case of Crohn's disease discovered in a follow-up of ileocolic adenocarcinoma.

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Section: Discussionmentioning

confidence: 99%

Crohn's disease discovered by colon adenocarcinoma

Boudabous¹,

Yasmine²,

Ayadi³

et al. 2020

GHOA

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“…A subset of dysplastic lesions may be followed up with continued surveillance instead of immediate surgical resection. Nevertheless, the persistent problems of interval carcinomas and undetected carcinomas and dysplasia highlight that endoscopic surveillance may not be feasible for all patients [79][80][81].…”

Section: Discussionmentioning

confidence: 99%

“…Cleveland et al [80] from the University of Chicago reported that for colectomy specimens resected for dysplasia or neoplasia identified on high-definition endoscopy in patients with inflammatory bowel disease between 2005 and 2014, synchronous invasive carcinoma was present in only 1 (3%) of 36 patients, but 8 (22%) patients had missed synchronous lesions of low-grade dysplasia or high-grade dysplasia. Eluri et al [81] from Johns Hopkins Hospital looked at resected specimens with high-grade dysplasia or carcinoma from patients with inflammatory bowel disease between 1994 and 2013 and found that in 70 patients 20 had either high-grade dysplasia or invasive carcinoma, which was missed on endoscopy (15 cases of high-grade dysplasia, 5 of carcinoma). Notably, there was no clear trend toward a decline in the proportion of undetected carcinoma or high-grade dysplasia over time, although correlation with high-definition endoscopy or chromoendoscopy could not be precisely determined.…”

Section: Surveillance Per the Scenic Guidelines And Associated Contromentioning

confidence: 99%

DALM, rest in peace: a pathologist's perspective on dysplasia in inflammatory bowel disease in the post-DALM era

2018

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There are few abbreviations in surgical pathology that are associated with as much immediate recognition, frustration, and confusion as DALM (dysplasia-associated lesion or mass). DALM is used to describe endoscopically visible dysplastic lesions in the surveillance of patients with inflammatory bowel disease. However, the diagnosis of DALM has been complicated by the inconsistent criteria and use of terminology for describing dysplasia in inflammatory bowel disease, and a tendency to relate DALM with the need for colectomy. Fortunately, advancements in both endoscopic visualization and local excision capability have allowed for a more defined management of dysplasia in inflammatory bowel disease. In 2015, the Surveillance for Colorectal Endoscopic Neoplasia Detection and Management in Inflammatory Bowel Disease Patients International Consensus Recommendations (SCENIC) Development Panel, a panel of predominantly expert gastroenterologists and endoscopists in surveillance of inflammatory bowel disease, published a consensus statement. One recommendation was to abandon DALM-related terminology in favor of endoscopic descriptors modified from the Paris endoscopic classification. Recommendations on surveillance and management of dysplastic lesions were also provided. Nevertheless, interval carcinomas and metachronous neoplasia remain persistent issues. This review aims to provide an update on the post-DALM terminology and management recommendations for inflammatory bowel disease-associated dysplasia necessary for a meaningful communication between pathologists and clinicians.

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“…Indeed, there is evidence that 12% of abnormalities, such as colonic polyps, will be missed on a single endoscopy. A recent study from the United States found that high‐grade dysplasia or colorectal cancer undetected on colonoscopy but found at colectomy was as high as 29% . The main distribution of such lesions was in the rectum and on the right side of the colon, possibly the least well‐evaluated areas on routine colonoscopies.…”

Section: Effectiveness Of Surveillancementioning

confidence: 99%

Surveillance for colorectal cancer and chemoprevention in ulcerative and Crohn's colitis: The need for clinical strategies to increase effectiveness

Farrukh

Mayberry

2019

JGH Open

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This review considers why current strategies for surveillance and the prevention of colorectal cancer as a long‐term complication are ineffective. The role of endoscopists, pathologists, and patients are investigated. Colorectal cancer is linked to poor compliance with therapy, and attention may be better directed at improving adherence to treatment than strengthening current surveillance programs. Clearly, 5‐ASA compounds, particularly mesalazine, are the most appropriate agents to choose, but there may also be a place for the daily intake of folic acid. Currently, the evidence in support of ursodeoxycholic acid is mixed, and it cannot be recommended, in general, to patients for the prophylaxis of colorectal cancer risk. An alternative approach through better concordance with medications is considered. The situation in Crohn's colitis is less clear. Although the risk of colorectal cancer mirrors that in ulcerative colitis, there are no published community‐based studies that exclusively assess the effects of surveillance on the early detection of cancer, and the benefits of 5‐ASA compounds in treatment seem less certain than in ulcerative colitis. In addition, there have been no assessments of the effects of any medications on cancer risk in Crohn's disease.

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Nearly a Third of High-Grade Dysplasia and Colorectal Cancer Is Undetected in Patients with Inflammatory Bowel Disease

Abstract: The prevalence of previously undetected HGD/CRC in IBD found at colectomy was 29%. The high proportion of undetected rectal and right-sided HGD/CRC suggests that these areas may need greater attention during surveillance.

Cited by 25 publications

References 20 publications

Crohn's disease discovered by colon adenocarcinoma

Crohn's disease discovered by colon adenocarcinoma

DALM, rest in peace: a pathologist's perspective on dysplasia in inflammatory bowel disease in the post-DALM era

Surveillance for colorectal cancer and chemoprevention in ulcerative and Crohn's colitis: The need for clinical strategies to increase effectiveness

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