Topic Highlight
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. May 7, 2008; 14(17): 2662-2669
Published online May 7, 2008. doi: 10.3748/wjg.14.2662
Colorectal cancer and dysplasia in inflammatory bowel disease
Timothy L Zisman, David T Rubin
Timothy L Zisman, Clinical Research Fellow in Gastro-enterology, the University of Chicago Medical Center, 5841 S. Maryland Avenue MC 4076, Chicago 60637, United States
David T Rubin, The University of Chicago Medical Center, 5841 S. Maryland Ave. MC 4080, Chicago, IL 60637, United States
Author contributions: Zisman TL performed the literature review and manuscript preparation; Rubin DT provided editing, revision and oversight.
Correspondence to: David T Rubin, MD, Associate Professor of Medicine, The University of Chicago Medical Center, 5841 S Maryland Avenue MC 4080, Chicago, IL 60637, United States.
Telephone: +1-773-7022950
Fax: +1-773-7025790
Received: December 19, 2007
Revised: January 17, 2008
Published online: May 7, 2008

Both ulcerative colitis and Crohn’s disease carry an increased risk of developing colorectal cancer. Established risk factors for cancer among patients with inflammatory bowel disease (IBD) include the younger age at diagnosis, greater extent and duration of disease, increased severity of inflammation, family history of colorectal cancer and coexisting primary sclerosing cholangitis. Recent evidence suggests that current medical therapies and surgical techniques for inflammatory bowel disease may be reducing the incidence of this complication. Nonetheless heightened vigilance and a careful, comprehensive approach to prevent or minimize the complications of invasive cancer are warranted in this unique cohort of patients. Current guidelines for the prevention and early detection of cancer in this high risk population are grounded in the concept of an inflammation-dysplasia-carcinoma sequence. A thorough understanding of the definition and natural history of dysplasia in IBD, as well as the challenges associated with detection and interpretation of dysplasia are fundamental to developing an effective strategy for surveillance and prevention, and understanding the limitations of the current approach to prevention. This article reviews the current consensus guidelines for screening and surveillance of cancer in IBD, as well as presenting the evidence and rationale for chemoprevention of cancer and a discussion of emerging technologies for the detection of dysplasia.

Keywords: Cancer, Dysplasia, Inflammatory bowel disease, Ulcerative colitis, Crohn’s disease, Chemoprevention