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Colon cancer screening and surveillance in inflammatory bowel disease.

Bae SI, Kim YS - Clin Endosc (2014)

Bottom Line: For the diagnosis of CRC in patients with IBD, screening endoscopy is recommended 8 to 10 years after the IBD diagnosis, and surveillance colonoscopy is recommended every 1 to 2 years thereafter.The recent development of targeted biopsies using chromoendoscopy and relatively newer endoscopic techniques helps in the early diagnosis of CRC in patients with IBD.A total proctocolectomy is advisable when high-grade dysplasia or multifocal low-grade dysplasia is confirmed by screening endoscopy or surveillance colonoscopy or if a nonadenoma-like dysplasia-associated lesion or mass is detected.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea.

ABSTRACT
Patients with inflammatory bowel disease (IBD) have an increased risk of developing colorectal cancer (CRC). Accordingly, the duration and anatomic extent of the disease have been known to affect the development of IBD-related CRC. When CRC occurs in patients with IBD, unlike in sporadic CRC, it is difficult to detect the lesions because of mucosal changes caused by inflammation. In addition, the tumor types vary with ill-circumscribed lesions, and the cancer is difficult to diagnose and remedy at an early stage. For the diagnosis of CRC in patients with IBD, screening endoscopy is recommended 8 to 10 years after the IBD diagnosis, and surveillance colonoscopy is recommended every 1 to 2 years thereafter. The recent development of targeted biopsies using chromoendoscopy and relatively newer endoscopic techniques helps in the early diagnosis of CRC in patients with IBD. A total proctocolectomy is advisable when high-grade dysplasia or multifocal low-grade dysplasia is confirmed by screening endoscopy or surveillance colonoscopy or if a nonadenoma-like dysplasia-associated lesion or mass is detected. Currently, pharmacotherapies are being extensively studied as a way to prevent IBD-related CRC.

No MeSH data available.


Related in: MedlinePlus

Algorithm for colorectal cancer screening and surveillance and treatment of dysplasia detected in patients with inflammatory bowel disease. DALM, dysplasia-associated lesion or mass.
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Figure 2: Algorithm for colorectal cancer screening and surveillance and treatment of dysplasia detected in patients with inflammatory bowel disease. DALM, dysplasia-associated lesion or mass.

Mentions: DALMs are often categorized as adenoma-like or nonadenoma-like. Evidence indicates that because adenoma-like DALMs tend to have a lower risk of malignancy than nonadenoma-like DALMs, they may be treated with endoscopic resection and continued regular follow-up if the lesion has been excised completely and no flat dysplasia is seen elsewhere in the colon.47 Complete proctocolectomy is proposed for nonadenoma-like DALMs because synchronous CRC has been reportedly found in up to 50% of cases (Fig. 2).48,49 With endoscopy, adenoma-like DALMs grossly appear as well-circumscribed, polypoid, and sessile lesions that do not usually accompany hemorrhage, ulceration, or necrosis, conversely, nonadenoma-like DALMs appear as irregular and ill-circumscribed lesions, usually accompanied by hemorrhage, ulceration, or necrosis.50 However, it is not always easy to distinguish between these two lesions by gross examination; therefore, resection and intense colonoscopic surveillance are advisable when no flat dysplasia is detected surrounding the lesion.51


Colon cancer screening and surveillance in inflammatory bowel disease.

Bae SI, Kim YS - Clin Endosc (2014)

Algorithm for colorectal cancer screening and surveillance and treatment of dysplasia detected in patients with inflammatory bowel disease. DALM, dysplasia-associated lesion or mass.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4260098&req=5

Figure 2: Algorithm for colorectal cancer screening and surveillance and treatment of dysplasia detected in patients with inflammatory bowel disease. DALM, dysplasia-associated lesion or mass.
Mentions: DALMs are often categorized as adenoma-like or nonadenoma-like. Evidence indicates that because adenoma-like DALMs tend to have a lower risk of malignancy than nonadenoma-like DALMs, they may be treated with endoscopic resection and continued regular follow-up if the lesion has been excised completely and no flat dysplasia is seen elsewhere in the colon.47 Complete proctocolectomy is proposed for nonadenoma-like DALMs because synchronous CRC has been reportedly found in up to 50% of cases (Fig. 2).48,49 With endoscopy, adenoma-like DALMs grossly appear as well-circumscribed, polypoid, and sessile lesions that do not usually accompany hemorrhage, ulceration, or necrosis, conversely, nonadenoma-like DALMs appear as irregular and ill-circumscribed lesions, usually accompanied by hemorrhage, ulceration, or necrosis.50 However, it is not always easy to distinguish between these two lesions by gross examination; therefore, resection and intense colonoscopic surveillance are advisable when no flat dysplasia is detected surrounding the lesion.51

Bottom Line: For the diagnosis of CRC in patients with IBD, screening endoscopy is recommended 8 to 10 years after the IBD diagnosis, and surveillance colonoscopy is recommended every 1 to 2 years thereafter.The recent development of targeted biopsies using chromoendoscopy and relatively newer endoscopic techniques helps in the early diagnosis of CRC in patients with IBD.A total proctocolectomy is advisable when high-grade dysplasia or multifocal low-grade dysplasia is confirmed by screening endoscopy or surveillance colonoscopy or if a nonadenoma-like dysplasia-associated lesion or mass is detected.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea.

ABSTRACT
Patients with inflammatory bowel disease (IBD) have an increased risk of developing colorectal cancer (CRC). Accordingly, the duration and anatomic extent of the disease have been known to affect the development of IBD-related CRC. When CRC occurs in patients with IBD, unlike in sporadic CRC, it is difficult to detect the lesions because of mucosal changes caused by inflammation. In addition, the tumor types vary with ill-circumscribed lesions, and the cancer is difficult to diagnose and remedy at an early stage. For the diagnosis of CRC in patients with IBD, screening endoscopy is recommended 8 to 10 years after the IBD diagnosis, and surveillance colonoscopy is recommended every 1 to 2 years thereafter. The recent development of targeted biopsies using chromoendoscopy and relatively newer endoscopic techniques helps in the early diagnosis of CRC in patients with IBD. A total proctocolectomy is advisable when high-grade dysplasia or multifocal low-grade dysplasia is confirmed by screening endoscopy or surveillance colonoscopy or if a nonadenoma-like dysplasia-associated lesion or mass is detected. Currently, pharmacotherapies are being extensively studied as a way to prevent IBD-related CRC.

No MeSH data available.


Related in: MedlinePlus