Colorectal Dysplasia and Cancer Surveillance in Ulcerative Colitis

Abstract

Ulcerative colitis (UC) is a risk factor for the development of inflammation-associated dysplasia or colitis-associated neoplasia (CAN). This transformation results from chronic inflammation, which induces changes in epithelial proliferation, survival, and migration via the induction of chemokines and cytokines. There are notable differences in genetic mutation profiles between CAN in UC patients and sporadic colorectal cancer in the general population. Colonoscopy is the cornerstone for surveillance and management of dysplasia in these patients. There are several modalities to augment the quality of endoscopy for the better detection of dysplastic or neoplastic lesions, including the use of high-definition white-light exam and image-enhanced colonoscopy, which are described in this review. Clinical practice guidelines regarding surveillance strategies in UC have been put forth by various GI societies, and overall, there is agreement between them except for some differences, which we highlight in this article. These guidelines recommend that endoscopically detected dysplasia, if feasible, should be resected endoscopically. Advanced newer techniques, such as endoscopic mucosal resection and endoscopic submucosal dissection, have been utilized in the treatment of CAN. Surgery has traditionally been the mainstay of treating such advanced lesions, and in cases where endoscopic resection is not feasible, a proctocolectomy, followed by ileal pouch-anal anastomosis, is generally recommended. In this review we summarize the approach to surveillance for cancer and dysplasia in UC. We also highlight management strategies if dysplasia is detected.

Ulcerative colitis and its correlation with the incidence of colorectal cancer

“…This feedback loop of inflammation, DNA damage, and cell growth ultimately leads to remodeling the extracellular matrix and metastases (Dulai et al, 2016;(Rennoll, 2015;Saraggi et al, 2017). Last but not least, disbiosis of genotoxic microorganisms has been shown to have implications as a risk factor for carcinogenesis through decreased production of anti-inflammatory cytokines, such as IL-10 ( Reznicek et al, 2021).…”

“…According to studies, about half of colorectal cancer cases can be prevented or managed through risk modification and screening (Fisher et al, 2021). However, the condition of ulcerative colitis and its subsequent development into colitis-associated neo-plasia (CAN) give a unique challenges related to the supervision and management of dysplasia (Reznicek et al, 2021). The type of unconventional dysplasia has been known, but its natural history has not been well defined.…”

Evidence-based pathogenesis and treatment of ulcerative colitis: A causal role for colonic epithelial hydrogen peroxide

“…All things considered, with current therapy and under the best of circumstances, UC patients must undergo life-long surveillance colonoscopy for colon cancer, which cannot detect all neoplastic lesions leading to a high mortality rate[ 29 , 294 , 295 ]. And although total colectomy has been touted as a cure for the approximately 30% of UC patients who fail medical therapy or develop colon cancer, studies have shown that patients who have undergone ileal pouch/anal anastomosis have higher disability scores than patients with active UC[ 296 ].…”

Colorectal cancer in ulcerative colitis (review)

“…Пациенты с ПСХ имеют более высокий риск развития КРР. Так, у больных с 20-летним анамнезом ЯК с сопутствующим ПСХ в 33% случаев был диагностирован КРР [17].…”