Advanced endoscopic imaging for surveillance for dysplasia and colorectal cancer in inflammatory bowel disease: Could the pathologist be further helped?

Abstract

Patients with inflammatory bowel disease (IBD) have an increased risk of developing intestinal cancer. The magnitude of that increased risk as well as how best to mitigate it remain a topic of ongoing investigation in the field. It is important to quantify the risk of colorectal cancer in association with IBD. The reported risk varies widely between studies. This is partly due to the different methodologies used in the studies. Because of the limitations of surveillance strategies based on the detection of dysplasia, advanced endoscopic imaging and techniques involving the detection of alterations in mucosal antigens and genetic abnormalities are being investigated. Development of new biomarkers, predicting future occurrence of colonic neoplasia may lead to more biomarker-based surveillance. There are promising results that may lead to more efficient surveillance in IBD patients and more general acceptance of its use. A multidisciplinary approach, involving in particular endoscopists and pathologists, together with a centralized patient management, could help to optimize treatments and follow-up measures, both of which could help to reduce the IBD-associated cancer risk.

Colorectal Carcinogenesis: Role of Oxidative Stress and Antioxidants

“…Moreover, the duration and the extent of the disease in the colon, as well as the cumulative effects of inflammation caused by continuous exposure of the mucosa to inflammatory stimuli are among the leading factors associated with the development of CRC in UC patients (6). However, for CD patients, this risk is associated with individual risk factors (7). Currently, it is clearly documented that any dysregulation or imbalance of the gut microbiota might lead to changes in colocytes as well as extraintestinal disease (5,6).…”

Guía práctica para el diagnóstico de displasia y de carcinoma colorrectal en la enfermedad inflamatoria intestinal

“…5 y 6). La implantación de estos avances puede ayudar a hacer detectables las lesiones que previamente no eran visibles y permitir resecar lesiones cada vez más extensas e irregulares y así evitar, al menos en algunos casos, la colectomía total 4,17,25 . De hecho, en la actualidad el tratamiento recomendado es la terapéutica endoscópica siempre que la lesión se considere resecable con esta técnica y no exista multifocalidad.…”

“…Además en la EC está aumentado el riesgo de carcinoma epidermoide anal y de adenocarcinoma tanto en el intestino delgado (en 60 veces), como en las fístulas perianales y en los segmentos con estenosis. Por último, en cuanto a incidencia de neoplasia, en la CU también está aumentada la de malignidades extracolónicas como el carcinoma de ductos biliares, la leucemia, los tumores óseos y el carcinoma endometrial, y en la EC la de carcinoma de vejiga 3,4 .…”