ReviewIntestinal and Extraintestinal Cancers Associated With Inflammatory Bowel Disease
Introduction
Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), is a lifelong immune-mediated chronic inflammatory disorder of the gastrointestinal tract. Both types of IBD are characterized by chronic inflammation with episodes of remission and relapses.1, 2 It is estimated that at least 0.4% of Europeans and North Americans live with IBD.2 IBD patients are associated with excess deaths from infection, cardiovascular diseases, and cancers.3 Malignancies are the second most common cause of death after cardiovascular diseases in men as well as in women with IBD.4
Inflammatory bowel disease patients are at increased risk of developing carcinoma of the gastrointestinal tract, including colorectal carcinoma and small bowel adenocarcinoma. CD as well as UC carry an increased risk with the greater risk associated with UC. More recently, patients with IBD have also been shown to be at increased risk of developing extraintestinal malignancies, such as lymphomas and skin cancers. This article focuses on the clinical and pathological features of IBD-related intestinal and extraintestinal malignancies.
Section snippets
Inflammatory Bowel Disease-Related Colorectal Cancer
Increased risk of intestinal cancers in IBD patients have been identified in studies of population-based registries, nationwide cohorts, and referral center cohorts.1, 5, 6, 7, 8
A meta-analysis of 116 studies by Eaden et al showed that the prevalence of colorectal cancer in patients with UC is approximately 3.7%.9 The development of cancer accounts for one-third of deaths related to UC. The risk begins to increase significantly above that of the general population approximately 8 to 10 years
Extraintestinal Malignancies Associated With IBD
Early and sustained healing of intestinal inflammation has become the ultimate objective of treatment in IBD. Immunosuppressant therapies, including thiopurines, antitumor necrosis factor, cyclosporine, and methotrexate are frequently necessary for IBD management. Immunosuppressant might be carcinogenic by directly altering cellular DNA, impairing immune control of chronic infection by mutagenic viruses, or reducing immunosurveillance of tumor cells.55, 56, 57 After adjusting for confounders,
Summary
Patients with IBD, including UC and CD, are at increased risk of developing intestinal and extraintestinal cancers. IBD-related malignancies are the second most common cause of death in both sexes of UC and CD patients. The risk for development of intestinal carcinomas in patients with UC and CD appears to depend on the duration of disease, the severity of disease, family history of colorectal cancer, and the presence of PSC. The colorectal cancer risk begins to increase significantly above
Disclosure
The authors have stated that they have no conflicts of interest.
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