Colorectal Cancer and Crohn’s Colitis: Clinical Implications From 313 Surgical Patients

Scaringi, Stefano; Martino, Carmela Di; Zambonin, Daniela; Fazi, Marilena; Canonico, Giuseppe; Leo, Francesca De; Ficari, Ferdinando; Tonelli, Francesco

doi:10.1007/s00268-013-1922-z

Cited by 18 publications

(20 citation statements)

References 41 publications

(44 reference statements)

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“…Colorectal cancer in CD usually develops at an earlier age when compared to the baseline population[27]. For patients with CD colitis, the risk of developing cancer is 3%-4%[28]. Severe ileitis is associated with increased risk of small bowel cancer (approximately 2%).…”

Section: Indications For Major Gastrointestinal Surgery In CDmentioning

confidence: 99%

“…Severe ileitis is associated with increased risk of small bowel cancer (approximately 2%). Dysplasia, earlier age of diagnosis of CD, extensive colitis or ileitis, length of disease > 10 years, presence of pseudopolyps (Figure 4), presence of anal fistula or other penetrating disease and primary sclerosing cholangitis is associated with increased risk of cancer in CD[28,29]. …”

Section: Indications For Major Gastrointestinal Surgery In CDmentioning

confidence: 99%

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Indications and surgical options for small bowel, large bowel and perianal Crohn's disease

Toh¹,

Stewart²,

Rickard³

et al. 2016

WJG

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Despite advancements in medical therapy of Crohn’s disease (CD), majority of patients with CD will eventually require surgical intervention, with at least a third of patients requiring multiple surgeries. It is important to understand the role and timing of surgery, with the goals of therapy to reduce the need for surgery without increasing the odds of emergency surgery and its associated morbidity, as well as to limit surgical recurrence and avoid intestinal failure. The profile of CD patients requiring surgical intervention has changed over the decades with improvements in medical therapy with immunomodulators and biological agents. The most common indication for surgery is obstruction from stricturing disease, followed by abscesses and fistulae. The risk of gastrointestinal bleeding in CD is high but the likelihood of needing surgery for bleeding is low. Most major gastrointestinal bleeding episodes resolve spontaneously, albeit the risk of re-bleeding is high. The risk of colorectal cancer associated with CD is low. While current surgical guidelines recommend a total proctocolectomy for colorectal cancer associated with CD, subtotal colectomy or segmental colectomy with endoscopic surveillance may be a reasonable option. Approximately 20%-40% of CD patients will need perianal surgery during their lifetime. This review assesses the practice parameters and guidelines in the surgical management of CD, with a focus on the indications for surgery in CD (and when not to operate), and a critical evaluation of the timing and surgical options available to improve outcomes and reduce recurrence rates.

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Section: Indications For Major Gastrointestinal Surgery In CDmentioning

confidence: 99%

Section: Indications For Major Gastrointestinal Surgery In CDmentioning

confidence: 99%

Indications and surgical options for small bowel, large bowel and perianal Crohn's disease

Toh¹,

Stewart²,

Rickard³

et al. 2016

WJG

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show abstract

“…Scaringi et al reported that CD patients who require surgery are at higher risk of the development of colorectal cancer, particularly those whose disease duration is >10 years, have distal localization, are <40-years-old at diagnosis, and have penetrating disease [12]. In the present study, the site of disease (colon involvement) at the first operation and age at the first operation were associated with an increased risk of the development of cancer in Japanese CD patients.…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological characteristics of cancer associated with Crohn’s disease

et al. 2016

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PurposeWe examined the clinicopathological characteristics and prognosis of patients with cancer associated with Crohn’s disease (CD).MethodsThe subjects of this study were patients with cancer confirmed in a resected specimen of bowel, who were treated at our institution between September, 1974 and December, 2014.ResultsWe analyzed 34 patients (26 men, 8 women, median age at cancer diagnosis 43.5 years, duration of illness 18 years) and found that the number of those with CD complicated with cancer began to drastically increase after 2005. The site of onset of cancer was in an anorectal lesion in 24 (70.6 %) patients. In 17 (50 %) patients, the cancer was diagnosed before surgery; in 3 patients (8.8 %), it was based on pathological findings during surgery; and in 14 patients (41.2 %), it was based on postoperative pathological findings. Mucinous carcinoma was the dominant histological type, seen in 15 patients (44.1 %), while the special type of signet-ring cell carcinoma was found in 4 patients. The cumulative overall 5 year survival rate was 46.2 %.ConclusionIn this group of Japanese CD patients, an anorectal lesion was the most frequent site of origin of cancer. As cancer was diagnosed preoperatively in only 50 % of these patients, the overall prognosis was poor, with a cumulative 5 year survival rate of just 46.2 %.

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“…A meta-analysis revealed that the overall relative risk of colorectal cancer was 4.5 in patients with the CD of colorectal disease, in comparison with 1.1 in the CD of ileal disease [110]. Furthermore, a clinicopathological analysis of 313 surgically treated patients with CD of colitis found 11 adenocarcinomas (3.5%); multivariate analysis revealed disease duration (>10 years), age at CD diagnosis, distal localization, and penetrating disease as significant risk factors [111]. Thus, colitic carcinomas develop in the CD of colitis, similarly to UC.…”

Section: Ibd (Ulcerative Colitis and Crohn's Disease Of The Colitis Tmentioning

confidence: 99%

Proposal for an Organ-Specific Chronic Inflammation–Remodeling–Carcinoma Sequence

Okayasu

Ichinoe

Yoshida

2019

Gastrointestinal Disorders

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An organ-specific chronic inflammation-remodeling-carcinoma sequence has been proposed, mainly for the alimentary tract. As representative diseases, gastroesophageal reflux disease, chronic gastritis and inflammatory bowel disease (ulcerative colitis and Crohn's disease of the colitis type) were adopted for this discussion. Tissue remodeling is such an important part of tumorigenesis in this sequence that an organ-specific chronic inflammation-remodeling-carcinoma sequence has been proposed in detail. Chronic inflammation accelerates the cycle of tissue injury and regeneration; in other words, cell necrosis (or apoptosis) and proliferation result in tissue remodeling in long-standing cases of inflammation. Remodeling encompasses epithelial cell metaplasia and stromal fibrosis, and modifies epithelial-stromal cell interactions. Further, the accumulation of genetic, epigenetic and molecular changes-as well as morphologic disorganization-also occurs during tissue remodeling. The expression of mucosal tissue adapted to chronic inflammatory injury is thought to occur at an early stage. Subsequently, dysplasia and carcinoma develop on a background of remodeling due to continuous, active inflammation. Accordingly, organ-specific chronic inflammation should be ameliorated or well controlled with appropriate monitoring if complete healing is unachievable.

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Colorectal Cancer and Crohn’s Colitis: Clinical Implications From 313 Surgical Patients

Cited by 18 publications

References 41 publications

Indications and surgical options for small bowel, large bowel and perianal Crohn's disease

Indications and surgical options for small bowel, large bowel and perianal Crohn's disease

Clinicopathological characteristics of cancer associated with Crohn’s disease

Proposal for an Organ-Specific Chronic Inflammation–Remodeling–Carcinoma Sequence

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