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

Abstract

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.

Correlation of ulcerative colitis and colorectal cancer: a systematic review and meta-analysis

“…CRC is a major long-term serious complication in patients with UC (22)(23)(24). Previous studies have shown that the main area of colon cancer incidence (25,26). Although recent studies have suggested that patients with UC do not have a particularly high rate of CRC conversion, the prevalence is still very high compared with the general population (27,28).…”

Metastatic Colorectal Cancer in two Young Patients with Inflammatory Bowel Disease – Relevance of Tight Endoscopic Surveillance Especially in Early-Onset IBD and Review of the Literature

“…Patients must be educated about the link between IBD and CRC, which is essential to guarantee adherence to treatment and surveillance protocols. In a study of 156 patients with colitis, only 50% were aware of the correlation between their disease and CRC [28,29]. Unfortunately, surveillance endoscopies are still not offered to all high-risk patients as recommended by the guidelines.…”