Colorectal cancer in inflammatory bowel disease: The risk, pathogenesis, prevention and diagnosis

Abstract

Patients with inflammatory bowel disease (IBD) are at increased risk for developing colorectal cancer (CRC), although the overall incidence of IBD-associated CRC has been diminishing in recent decades in western countries. As demonstrated in previous studies, the risk of CRC in IBD increases with longer duration, extent of colitis, a familial history of CRC, coexistent primary sclerosing cholangitis, and the degree of inflammation. The pathogenesis of CRC in IBD is poorly understood. Similar to sporadic CRC, IBD-associated CRC is a consequence of sequential episodes of genomic alteration. Multiple inter-related pathways, including immune response by mucosal inflammatory mediators, oxidative stress, and intestinal microbiota, are also involved the pathogenesis of IBD-associated CRC. Continuing colonic inflammation appears to be a factor in the development of CRC; therefore, anti-inflammatory agents such as 5-aminosalicylate compounds and immune modulators have been considered as potential chemopreventive agents. Colonoscopic surveillance is widely accepted as being effective in reducing the risk of IBD-associated CRC, although no clear evidence has confirmed that surveillance colonoscopy prolongs survival in patients with extensive colitis. The traditional recommendation has been quadrantic random biopsies throughout the entire colon; however, several guidelines now have endorsed chromoendoscopy with a target biopsy because of increasing diagnostic yields and reduced workloads for endoscopists and pathologists. New technologies such as narrow band imaging, confocal endomicroscopy, and autofluorescence imaging have not yet been confirmed as surveillance strategies in IBD.

Novel insights into Notum and glypicans regulation in colorectal cancer

“…inflammatory background observed in other mouse models, which proceed through repeated cycles of DSS administration (one injection of AOM, three cycles of DSS). In that case, the inflammation becomes chronic and non-resolved [24], as seen in human IBD-related CRC where chronic inflammation always precedes and is directly linked to tumor formation [25,26]. Changes in gene expression are extensive in those models, especially in genes involved in the inflammatory response and immune defence [27].…”

Anti-inflammatory natural product goniothalamin reduces colitis-associated and sporadic colorectal tumorigenesis

“…For example, inflammatory bowel diseases (IBD), such as Crohn's disease and ulcerative colitis, are important risk factors for a type of colon cancer known as colitis-associated cancer (CAC), which represents 2% of all CRC cases (5). Individuals with ulcerative colitis have dramatically increased risk of developing colon cancer, with an incidence up to 20% after 30 years of ulcerative colitis (5,6). Chronic intestinal inflammation is characterized by overproduction of pro-inflammatory cytokines and intense immune cell infiltrate, which favor the initiation and progression towards a malignant state, as inflammation has the potential to cause mutations due to the production of reactive oxygen species (ROS) by inflammatory cells (7,8).…”

Transición del adolescente con enfermedad inflamatoria intestinal desde la atención pediátrica a la del adulto

“…Los pacientes con EII tienen un mayor riesgo de cáncer colorrectal asociado a menor edad al diagnósti-co, enfermedad de larga data, mayor severidad y extensión, presencia de colangitis esclerosante primaria y antecedentes familiares de cáncer colorrectal 21 . Aunque en Pediatría, el cáncer colorrectal es una complicación infrecuente, es importante la vigilancia, ya que después de 10 años de diagnosticada la EII el riesgo aumenta gradualmente, variando de una probabilidad de 4,4% a los 10 años, 8,6% a los 20 años, hasta alcanzar 43% a los 35 años del diagnóstico 22 .…”