Incident Colorectal Cancer in Inflammatory Bowel Disease

SIMPLE SUMMARY: The sequence chronic inflammation-dysplasia-cancer is involved in the development of several gastrointestinal cancers, including colorectal cancer (CRC) in Inflammatory Bowel Disease (IBD). Several risk factors for CRC are recognized in Ulcerative Colitis (UC) and Crohn’s Disease (CD) colitis. The combined role of IBD characteristics and incident CRC, including CRC-related symptoms at onset, in determining the long-term outcome needs further investigation. These issues were addressed in our multicenter study in IBD patients with incident CRC. CRC was more frequently diagnosed by colonoscopy in UC and by imaging in CD. CRC occurred in one fourth of patients at a young age (≤40 years), and a high rate of CRC-related mortality was observed, particularly in patients with CRC diagnosed at an older age. The present findings from incident CRC in IBD support the need to focus the attention on surveillance programs in subgroups of patients at higher risk for CRC and CRC-related death. ABSTRACT: Colorectal cancer (CRC) risk is increased in Inflammatory Bowel Disease (IBD) and surveillance needs to be tailored according to individual risk. The open issues include the role of the characteristics of IBD and CRC in determining the long-term outcome. These issues were assessed in our multicenter study, including a cohort of 56 IBD patients with incident CRC. The clinical and histopathological features of IBD patients and of CRC were recorded. Incident CRC in IBD occurred at a young age (≤40 years) in 25% of patients (median age 55.5 (22–76)). Mucinous signet-ring carcinoma was detected in 6 out of the 56 (10.7%) patients, including 4 with Ulcerative Colitis (UC) and 2 with Crohn’s disease (CD). CRC was more frequently diagnosed by colonoscopy in UC (85.4% vs. 50%; p = 0.01) and by imaging in Crohn’s Disease CD (5.8% vs. 31.8%; p = 0.02). At onset, CRC-related symptoms occurred in 29 (51.9%) IBD patients. The time interval from the diagnosis of IBD to CRC was shorter in UC and CD patients with >40 years (p = 0.002; p = 0.01). CRC-related death occurred in 10 (29.4%) UC and in 6 (27.2%) CD patients (p = 0.89), with a short time interval from CRC to death (UC vs. CD: 6.5 (1–68) vs. 14.5 (8–40); p = 0.85; IBD: 12 months (1–68)). CRC occurring at a young age, a short time interval from the diagnosis of IBD to CRC-related death in the elderly, CRC-symptoms often mimicking IBD relapse and the observed high mortality rate may support the need of closer surveillance intervals in subgroups of patients.