Review
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Aug 15, 2023; 15(8): 1317-1331
Published online Aug 15, 2023. doi: 10.4251/wjgo.v15.i8.1317
Update and latest advances in mechanisms and management of colitis-associated colorectal cancer
Wan-Yue Dan, Guan-Zhou Zhou, Li-Hua Peng, Fei Pan
Wan-Yue Dan, Guan-Zhou Zhou, Li-Hua Peng, Fei Pan, Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
Wan-Yue Dan, Guan-Zhou Zhou, Medical School, Nankai University, Tianjin 300071, China
Author contributions: Pan F established the design and conception of the paper; Dan WY searched the literature and drafted the manuscript; Pan F, Dan WY, Zhou GZ, and Peng LH checked the manuscript and critically revised the important intellectual content in this manuscript; and all authors have read and agreed to the published version of the manuscript.
Supported by the National Key Research and Development Program, No. 2022YFC2504003; Young Scholar Independent Innovation Science Fund of Chinese PLA General Hospital, No. 22QNCZ020; and Medical Science and Technology Young Scholar Fostering Fund, No. 21QNPY109.
Conflict-of-interest statement: The authors declare no conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fei Pan, MD, PhD, Associate Chief Physician, Associate Professor, Deputy Director, Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, China. panfei@plagh.org
Received: March 30, 2023
Peer-review started: March 30, 2023
First decision: June 17, 2023
Revised: July 3, 2023
Accepted: July 25, 2023
Article in press: July 25, 2023
Published online: August 15, 2023
Processing time: 133 Days and 0 Hours
Abstract

Colitis-associated colorectal cancer (CAC) is defined as a specific cluster of colorectal cancers that develop as a result of prolonged colitis in patients with inflammatory bowel disease (IBD). Patients with IBD, including ulcerative colitis and Crohn’s disease, are known to have an increased risk of developing CAC. Although the incidence of CAC has significantly decreased over the past few decades, individuals with CAC have increased mortality compared to individuals with sporadic colorectal cancer, and the incidence of CAC increases with duration. Chronic inflammation is generally recognized as a major contributor to the pathogenesis of CAC. CAC has been shown to progress from colitis to dysplasia and finally to carcinoma. Accumulating evidence suggests that multiple immune-mediated pathways, DNA damage pathways, and pathogens are involved in the pathogenesis of CAC. Over the past decade, there has been an increasing effort to develop clinical approaches that could help improve outcomes for CAC patients. Colonoscopic surveillance plays an important role in reducing the risk of advanced and interval cancers. It is generally recommended that CAC patients undergo endoscopic removal or colectomy. This review summarizes the current understanding of CAC, particularly its epidemiology, mechanisms, and management. It focuses on the mechanisms that contribute to the development of CAC, covering advances in genomics, immunology, and the microbiome; presents evidence for management strategies, including endoscopy and colectomy; and discusses new strategies to interfere with the process and development of CAC. These scientific findings will pave the way for the management of CAC in the near future.

Keywords: Colitis-associated colorectal cancer; Inflammatory bowel disease; Colonoscopic surveillance; Epidemiology; Mechanisms; Management

Core Tip: Colitis-associated colorectal cancer (CAC) is defined as a specific cluster of colorectal cancers that develop as a result of prolonged colitis in patients with inflammatory bowel disease (IBD). Patients with IBD are known to have an increased risk of developing CAC. Accumulating evidence suggests that multiple immune-mediated pathways, DNA damage pathways, and pathogens are involved in the pathogenesis of CAC. This review summarizes the current understanding of CAC, particularly its epidemiology, mechanisms, and management. These scientific findings will pave the way for the management of CAC in the near future.