More right-sided IBD-associated colorectal cancer in patients with primary sclerosing cholangitis

Abstract

The right colon is the predilection site for development of colonic malignancies in patients with PSC and IBD. When such patients are diagnosed with cancer they tend to have more advanced tumors than patients with IBD without concurrent PSC, and the overall prognosis is worse. Furthermore, the higher frequency of right-sided tumors in patients with PSC suggests a different pathogenesis between patients with PSC and IBD and those with IBD alone.

Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline

“…PSC-associated colitis seems to be distinctive from other IBD: Colitis is predominant in the right colon (128), and colon cancer is typically right-sided (129). Lack of inflammation in the rectum ('rectal sparing') is reported in some studies but less frequently observed in others (3).…”

S3-Leitlinie – Kolorektales Karzinom

“…Da bei einer Proktitis das Karzinomrisiko allenfalls minimal erhöht ist, mussbei Fehlen sonstiger Risikofaktoren -keine regelhafte Überwa-chung erfolgen. Da das Karzinomrisiko bei Patienten mit CU und einer PSC 5-fach erhöht ist [405] und Karzinome gehäuft rechtsseitig auftreten [404], sollte bei diesen Patienten eine Überwa-chung ab Diagnosestellung unabhängig vom Befall jährlich erfolgen. [413,414].…”

Endoscopic Surveillance in Crohn’s Disease and Ulcerative Colitis: Who Needs What and When?

“…A special risk group includes patients with primary sclerosing cholangitis. Epidemiological data indicate that these patients carry an even higher risk of developing colorectal cancer and their tumors are more frequently located in the ascending colon [8,9]. According to a retrospective multicenter series from the Netherlands, the survival in patients with primary cholangitis after diagnosing colorectal cancer was lower (5-year survival: 40 vs. 75%, p = 0.001) and right-sided tumors were more prevalent in the primary cholangitis group (67 vs. 36%, p = 0.006) [10].…”