Colorectal cancer in patients with inflammatory bowel disease after liver transplantation for primary sclerosing cholangitis

Vera, Alonso; Gunson, Bridget K.; Ussatoff, Val; Nightingale, Peter; Candinas, Daniel; Radley, Simon; Mayer, A. D.; Buckels, J. A. C.; McMaster, P; Neuberger, James; Mirza, Darius F.

doi:10.1097/01.tp.0000058744.34965.38

Cited by 164 publications

(114 citation statements)

References 22 publications

(31 reference statements)

Supporting

Mentioning

111

Contrasting

Unclassified

Order By: Relevance

“…169 More important has been colon cancer, which is common, particularly in patients with preexisting ulcerative colitis. 167,170 The cumulative risk for colon cancer is 14% at 5 years and 17% at 10 years. Routine surveillance colonoscopy is recommended, and UDCA is commonly used as means of decreasing the risk of colon cancer, although neither practice has been proven to be effective in this situation.…”

Section: Session Six Liver Transplantation For Pscmentioning

confidence: 99%

“…150,[162][163][164][165][166] Factors associated with recurrence were steroid-resistant rejection, OKT3 use, preservation injury, ABO incompatibility, cytomegalovirus infection, lack of history of colectomy, male sex, and donor-recipient gender mismatch, but not specific calcineurin inhibitor use or frequency of rejection. [162][163][164][165][166][167] A critical issue is whether recurrence of PSC adversely affects outcome. Instances of graft failure due to recurrent PSC are rare and often confounded by the presence of other forms of liver injury.…”

Section: Session Six Liver Transplantation For Pscmentioning

confidence: 99%

See 1 more Smart Citation

Primary sclerosing cholangitis: Summary of a workshop

et al. 2006

View full text Add to dashboard Cite

Primary sclerosing cholangitis (PSC) is a rare but important liver disease that leads to cirrhosis and need for liver transplantation in a high proportion of cases. The disease occurs in approximately 1 per 100,000 population per year, usually presents in adulthood, and affects men more often than women. Typical serum biochemical results, autoantibodies and liver biopsy are suggestive but not diagnostic of PSC, the diagnosis requiring cholangiographic demonstration of stricturing and dilatation of the intra-and/or extra-hepatic bile ducts. The natural history of PSC is variable, the average survival being 12 to 17 years. The cause of PSC is still unknown. Although considered an autoimmune disease, PSC has several atypical features and a strong genetic component. The therapy of PSC is unsatisfactory. Standard doses of ursodeoxycholic acid (UDCA) lead to improvements in biochemical abnormalities but not in histology, cholangiographic appearance or survival. Several innovative therapies have been tried in PSC, but with scant evidence of benefit. For patients with high grade strictures, endoscopic dilatation is beneficial. Liver transplantation is successful for end-stage liver disease due to PSC and improves survival. PSC may recur after transplantation but is rarely progressive. The most dreaded complication of PSC is cholangiocarcinoma. Diagnosis of this highly malignant tumor is difficult, and there are no biomarkers for its early detection. Liver transplantation for cholangiocarcinoma has an exceedingly poor outcome, although transplantation with neoadjuvant chemoirradiation holds promise in selected patients. Thus, significant opportunities remain for basic and clinical research into the cause, natural history, and therapy of PSC. 44:746-764.)

show abstract

Section: Session Six Liver Transplantation For Pscmentioning

confidence: 99%

Section: Session Six Liver Transplantation For Pscmentioning

confidence: 99%

Primary sclerosing cholangitis: Summary of a workshop

et al. 2006

View full text Add to dashboard Cite

show abstract

“…Important risk factors include primary sclerosing cholangitis (PSC) [25][26][27] , family history of CRC [28] , whereas the role of other factors, such as age at onset of UC, frequency of flare-ups, severity of inflammation [29] , "backwash ileitis" [30] , smoking, medical therapy used (5-aminosalycilates, azathioprine) [31] , is more controversial.…”

Section: Risk Factors For Colorectal Cancer In Ulcerative Colitismentioning

confidence: 99%

Risk for colorectal cancer in ulcerative colitis: Changes, causes and management strategies

Lakatos¹,

Lakatos²

2008

WJG

357

245

View full text Add to dashboard Cite

Since the first report of an inflammatory bowel disease (IBD) case associated with colorectal cancer (CRC) by Crohn and Rosenberg [1] , significant efforts have been made to elucidate this presumed association. Nowadays, the association between IBD and the increased risk for CRC is widely accepted. Although CRC, complicating ulcerative colitis and Crohn's disease, accounts only for 1%-2% of all cases of CRC in the general population, it is considered a serious complication of the disease and accounts for approximately 10%-15% of all deaths in IBD patients [2] . The age at diagnosis of CRC associated with IBD is 15-20 years earlier compared to sporadic cancers. In the meta-analysis by Eaden et al [3] , the average age at diagnosis was 43.2 years. Similarly, in a recent publication from Eastern Europe [4] , it was found to be 50.9 years, 10-15 years younger compared to sporadic CRC cases from the same area (62.2 years) [5] . According to US [6] and Canadian [7] publications, almost two-thirds of the affected patients were males, yet results are conflicting [4,8] . In addition, the frequency of multiple CRCs is higher than in patients with sporadic CRC [9] .The increased risk of CRC in UC is almost a universal finding [3,[10][11][12][13] , yet the extent of this risk varies considerably with differences in study design and geographic area. The initial reports were published by tertiary gastroenterology centers, thus the high risk detected might have been a consequence of referral bias and overinterpretation due to the high percentage of extensive and chronically active cases in these cohorts. Results of population-based studies are more reliable; however, several geographical and ethnic differences have been noted.The report of the meta-analysis by Eaden et al [3] in 2001 was one of several milestones in this subject. The incidence of UC-associated CRC was estimated based on 116 articles involving 54 478 patients in whom 1698 CRC cases were detected. This was a mixture of referral center-based, hospital-based, and population-based studies of variable methodological qualities and levels of detail. The reported incidence was higher in the US AbstractThe risk of colorectal cancer for any patient with ulcerative colitis is known to be elevated, and is estimated to be 2% after 10 years, 8% after 20 years and 18% after 30 years of disease. Risk factors for cancer include extent and duration of ulcerative colitis, primary sclerosing cholangitis, a family history of sporadic colorectal cancer, severity of histologic bowel inflammation, and in some studies, young age at onset of colitis. In this review, the authors discuss recent epidemiological trends and causes for the observed changes. Population-based studies published within the past 5 years suggest that this risk has decreased over time, despite the low frequency of colectomies. The crude annual incidence rate of colorectal cancer in ulcerative colitis ranges from approximately 0.06% to 0.16% with a relative risk of 1.0-2.75. The exact mechanism for this chang...

show abstract

“…Initially early diagnosis was associated with increased risk [16,19], while other work has demonstrated the opposite effect, with those who are elderly at diagnosis at higher risk [62,63]. Male gender also increase the risk Primary sclerosing cholangitis confers a 4-fold increase in risk of CRC development in UC patients [17,[64][65][66], with the increased risk persisting following liver transplantation [67,68].…”

Section: Risk Factorsmentioning

confidence: 89%