Risk of Cancer in Patients with Inflammatory Bowel Diseases and Keys for Patient Management

Abstract

Chronic inflammation in patients with Inflammatory Bowel Disease (IBD) leads to an increased risk of colorectal cancer, small bowel cancer, intestinal lymphoma and cholangiocarcinoma. However, treatments for IBD have also been associated with an increased risk of neoplasms. Patients receiving Thiopurines (TPs) have an increased risk of hematologic malignancies, non-melanoma skin cancer, urinary tract neoplasms and cervical cancer. Anti-TNFs have been associated with a higher risk of neoplasms, mainly lymphomas and melanomas; however, the data are controversial, and some recent studies do not confirm the association. Nevertheless, other biologic agents, such as ustekinumab and vedolizumab, have not shown an increased risk of any neoplasm to date. The risk of malignancies with tofacitinib exists, but its magnitude and relationship with previous treatment with TPs is not defined, so more studies from daily clinical practice are needed. Although biologic therapy seems to be safe for patients with current cancer or a prior history of cancer, as has been demonstrated in other chronic inflammatory conditions, prospective studies in this specific population are needed. Until that time, it is crucial to manage such conditions via the combined clinical expertise of the gastroenterologist and oncologist.

A Whole Food Plant-Based Approach to Ulcerative Colitis; A Case Series

“…All of these medications suppress the immune system and therefore increase the risk of infection and potentially cancer. 13 Treatment-free remission can be challenging to achieve, with most patients experiencing a relapse on discontinuation of therapy. 14,15 Thus, a therapeutic dietary approach is an attractive option given the lack of side effects and the potential to limit medication use.…”

Adalimumab-associated Philadelphia chromosome positive acute lymphoblastic leukaemia in a patient with Crohn’s disease

“…Numerous inquiries have delved into the interplay between inflammatory bowel disease (IBD) and the potential risk of haematopoietic cancer 14. Noteworthy among these studies is the work by Askling et al , which has enriched this ongoing discussion.…”

Meta‐analysis: Risk of pancreatic cancer in patients with inflammatory bowel disease

“…Finally, for both study purposes, we excluded articles from further investigation if they met any of the following criteria: (1) Reviews, case reports, editorials or letters to the editor; (2) Being published as duplicate or appraising the same population; (3) Conducting on children; (4) Lacking clear presentation of information concerning their methodology or findings related to the study outcomes.…”

“…3 Chronic inflammation through DNA damage, encouraging cell proliferation, and impairing the immune system can promote cancer development, accounting for the increased risk of various cancers in chronic inflammatory diseases like IBD. 4,5 Pancreatic cancer is a devastating malignancy with a very poor prognosis because it is usually clinically silent until it presents at an advanced incurable stage. 6 Pancreatic cancer is on the rise worldwide and is projected to be a significant public health concern, with an estimated incidence rate of 18.6 per 100,000 in 2050.…”

“…Having a family member with IBD is the most significant risk factor for developing the disease 3 . Chronic inflammation through DNA damage, encouraging cell proliferation, and impairing the immune system can promote cancer development, accounting for the increased risk of various cancers in chronic inflammatory diseases like IBD 4,5 …”