Top

Published in:

01-04-2013

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

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

Published in: World Journal of Surgery | Issue 4/2013

Abstract

Background

The relation between Crohn’s colitis (CC) and colorectal cancer is still controversial. Several case reports and retrospective studies have shown that patients with Crohn’s disease (CD) have a 6- to 20-fold higher risk to develop CRC than does the normal population. The extent of disease (extensive colitis), presence of anal fistula, age > 40 years, strictures, and length of disease >10 years may be important determinants for increasing risk. Despite this evidence, other population-based studies have shown no increased risk of colon or rectal cancer. The aim of this study was to investigate retrospectively factors that may predict the development of cancer.

Methods

We searched the histopathologic database of the Digestive Surgery Unit at Careggi University Hospital for CC patients (January 1987 to September 2011) and identified 313 patients with CC who underwent surgery.

Results

There are 11 (3.5 %) of adenocarcinomas. Multivariate analysis showed disease duration (p = 0.001), age at CD diagnosis (p = 0.002), distal localization (p = 0.045), and penetrating disease (p = 0.041) to be risk factors. Multivariate analysis showed that 40 patients who had undergone previous immunosuppressive therapy had a significant risk of developing CRC (p = 0.026).

Conclusions

Crohn’s colitis patients who require surgery are at higher risk for developing CRC, particularly those whose disease duration is >10 years, have distal localization, age at diagnosis was <40 years, and have penetrating disease. Previous immunosuppressive therapy should be better investigated. We recommend surgery for any patient presenting with colonic strictures.

Brostrom O, Lofberg R, Nordenvall B et al (1987) The risk of colorectal cancer in ulcerative colitis: an epidemiologic study. Scand J Gastroenterol 22:1193–1199PubMedCrossRef

Dawson IM, Pryse-Davies J (1959) The development of carcinoma of the large intestine in ulcerative colitis. Br J Surg 47:113–128PubMedCrossRef

Eaden JA, Abrams KR, Mayberry JF (2001) The risk of colorectal cancer in ulcerative colitis: a meta-analysis. Gut 48:526–535PubMedCrossRef

Gyde SN, Prior P, Allan RN et al (1988) Colorectal cancer in ulcerative colitis: a cohort study of primary referrals from three centres. Gut 29:206–217PubMedCrossRef

Lashner BA, Silverstein MD, Hanauer SB (1989) Hazard rates for dysplasia and cancer in ulcerative colitis: results from a surveillance program. Dig Dis Sci 34:1536–1541PubMedCrossRef

Lennard-Jones JE, Melville DM, Morson BC et al (1990) Precancer and cancer in extensive ulcerative colitis: findings among 401 patients over 22 years. Gut 31:800–806PubMedCrossRef

Lindberg B, Persson B, Veress B et al (1996) Twenty years’ colonoscopic surveillance of patients with ulcerative colitis: detection of dysplastic and malignant transformation. Scand J Gastroenterol 31:1195–1204PubMedCrossRef

Maratka Z, Nedbal J, Kocianova J et al (1985) Incidence of colorectal cancer in proctocolitis: a retrospective study of 959 cases over 40 years. Gut 26:43–49PubMedCrossRef

Sachar DB, Greenstein AJ (1981) Cancer in ulcerative colitis: good news and bad news. Ann Intern Med 95:642–644PubMed

10.

Bernstein D, Rogers A (1996) Malignancy in Crohn’s disease. Am J Gastroenterol 91:434–440PubMed

11.

Connell WR, Sheffield JP, Kamm MA et al (1994) Lower gastrointestinal malignancy in Crohn’s disease. Gut 35:347–352PubMedCrossRef

12.

Ekbom A, Helmick C, Zack M et al (1990) Increased risk of large-bowel cancer in Crohn’s disease with colonic involvement. Lancet 336:349–357CrossRef

13.

Gillen CD, Walmsley RS, Prior P et al (1994) Ulcerative colitis and Crohn’s disease: a comparison of the colorectal cancer risk in extensive colitis. Gut 35:1590–1592PubMedCrossRef

14.

Maykel JA, Hagerman G, Mellgren AF et al (2006) Crohn’s colitis: the incidence of dysplasia and adenocarcinoma in surgical patients. Dis Colon Rectum 49:950–957PubMedCrossRef

15.

Michelassi F, Testa G, Pomidor WJ et al (1993) Adenocarcinoma complicating Crohn’s disease. Dis Colon Rectum 36:654–661PubMedCrossRef

16.

Weedon DD, Shorter RG, Ilstrup DM et al (1973) Crohn’s disease and cancer. N Engl J Med 289:1099–1103PubMedCrossRef

17.

Bernstein CN, Blanchard JF, Kliewer E et al (2001) Cancer risk in patients with inflammatory bowel disease: a population-based study. Cancer 91:854–862PubMedCrossRef

18.

Binder V, Hendriksen C, Kreiner S (1985) Prognosis in Crohn’s disease based on results from a regional patient group from the county of Copenhagen. Gut 26:146–150PubMedCrossRef

19.

Gollop JH, Phillips SF, Melton LJ III et al (1988) Epidemiologic aspects of Crohn’s disease: a population based study in Olmsted County, Minnesota, 1943–1982. Gut 29:49–56PubMedCrossRef

20.

Persson PG, Karlen P, Bernell O et al (1994) Crohn’s disease and cancer: a population-based cohort study. Gastroenterology 107:1675–1679PubMed

21.

Collins PD, Mpofu C, Watson AJ, et al (2006) Strategies for detecting colon cancer and/or dysplasia in patients with inflammatory bowel disease. Cochrane Database Syst Rev (2):CD000279

22.

Fireman Z, Grossman A, Lilos P et al (1989) Intestinal cancer in patients with Crohn’s disease: a population study in central Israel. Scand J Gastroenterol 24:346–350PubMedCrossRef

23.

Jess T, Gamborg M, Matzen P et al (2005) Increased risk of intestinal cancer in Crohn’s disease: a meta-analysis of population-based cohort studies. Am J Gastroenterol 100:2724–2729PubMedCrossRef

24.

de Ponz LM, Marino M, Benatti P et al (2004) Trend of incidence, subsite distribution and staging of colorectal neoplasms in the 15-year experience of a specialised cancer registry. Ann Oncol 15:940–946CrossRef

25.

Beaugerie L, Brousse N, Bouvier AM et al (2009) Lymphoproliferative disorders in patients receiving thiopurines for inflammatory bowel disease: a prospective observational cohort study. Lancet 374:1617–1625PubMedCrossRef

26.

Biancone L, Orlando A, Kohn A et al (2006) Infliximab and newly diagnosed neoplasia in Crohn’s disease: a multicentre matched pair study. Gut 55:228–233PubMedCrossRef

27.

Biancone L, Petruzziello C, Orlando A et al (2011) Cancer in Crohn’s Disease patients treated with infliximab: a long-term multicenter matched pair study. Inflamm Bowel Dis 17:758–766PubMedCrossRef

28.

Mackey AC, Green L, Liang LC et al (2007) Hepatosplenic T cell lymphoma associated with infliximab use in young patients treated for inflammatory bowel disease. J Pediatr Gastroenterol Nutr 44:265–267PubMedCrossRef

29.

Shale M, Kanfer E, Panaccione R et al (2008) Hepatosplenic T cell lymphoma in inflammatory bowel disease. Gut 57:1639–1641PubMedCrossRef

30.

Van Schaik FD, van Oijen MG, Smeets HM et al (2012) Thiopurines prevent advanced colorectal neoplasia in patients with inflammatory bowel disease. Gut 61:235–240PubMedCrossRef

31.

Kiesslich R, Neurath MF (2004) Surveillance colonoscopy in ulcerative colitis: magnifying chromoendoscopy in the spotlight. Gut 53:165–167PubMedCrossRef

32.

Kiesslich R, Goetz M, Lammersdorf K et al (2007) Chromoscopy-guided endomicroscopy increases the diagnostic yield of intraepithelial neoplasia in ulcerative colitis. Gastroenterology 132:874–882PubMedCrossRef

33.

Hurlstone DP, McAlindon ME, Sanders DS et al (2004) Further validation of high-magnification chromoscopic-colonoscopy for the detection of intraepithelial neoplasia and colon cancer in ulcerative colitis. Gastroenterology 126:376–378PubMedCrossRef

34.

Ullman TA (2007) Chromoendoscopy should be the standard method and more widely used for cancer surveillance colonoscopy in ulcerative colitis. Inflamm Bowel Dis 13:1273–1274PubMedCrossRef

35.

Kuiper T, van den Broek FJ, van Eeden S et al (2012) Feasibility and accuracy of confocal endomicroscopy in comparison with narrow-band imaging and chromoendoscopy for the differentiation of colorectal lesions. Am J Gastroenterol 107:543–550PubMedCrossRef

36.

Lansdorp-Vogelaar I, Kuntz KM, Knudsen AB et al (2010) Stool DNA testing to screen for colorectal cancer in the Medicare population: a cost-effectiveness analysis. Ann Intern Med 153:368–377PubMed

37.

Osborn NK, Ahlquist DA (2005) Stool screening for colorectal cancer: molecular approaches. Gastroenterology 128:192–206PubMedCrossRef

Title: Colorectal Cancer and Crohn’s Colitis: Clinical Implications From 313 Surgical Patients
Authors: Stefano Scaringi
Carmela Di Martino
Daniela Zambonin
Marilena Fazi
Giuseppe Canonico
Francesca Leo
Ferdinando Ficari
Francesco Tonelli
Publication date: 01-04-2013
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 4/2013
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-013-1922-z

At a glance: The STEP trials

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 4/2013

A Nodal Positivity Constant: New Perspectives in Lymph Node Evaluation and Colorectal Cancer

PET Could Predict Response to Neoadjuvant Therapy and Long-Term Survival of Patients with Esophageal Cancer

Laparoscopic Surgery for Rectal Cancer: Outcomes in 513 Patients

How Many Contralateral Papillary Thyroid Carcinomas Can Be Missed?

A Higher Glomerular Filtration Rate Predicts Low Risk of Developing Chronic Kidney Disease in Living Kidney Donors

Drainage Volume After Pancreaticoduodenectomy Is a Warning Sign of Chyle Leakage That Inversely Correlates With a Diagnosis of Pancreatic Fistula