IBD and Colorectal Cancer: Ke... Video Transcript

Participants

, Steven H. Itzkowitz MD, Edward V. Loftus Jr, MD, David Rubin MD, Thomas A. Ullman MD

Summary

Doctors say regular colon cancer screening is important for people with long-term inflammatory bowel disease (IBD). Listen as experts explain how IBD patients can maximize their chances of an early diagnosis.

Webcast Transcript

ANNOUNCER: People with inflammatory bowel disease have an increased risk of developing colorectal cancer, compared to the general population. But doctors caution: the risk must be kept in perspective.

DAVID T. RUBIN, MD: Well, this remains a rare complication of this disease. But the studies that have estimated the lifelong prevalence of this condition or the risk overall is about 3.6 percent or 3.5 percent or three people out of a hundred, in their lifetime, might develop this condition.

We can break it down further, if we actually ask what's the likelihood over time, because time is a significant variable. Two percent after eight years of inflammation, eight percent after twenty years of disease and eighteen percent after thirty years of disease.

ANNOUNCER: All patients with ulcerative colitis face this increased risk. So do some people with Chron's disease.

THOMAS A. ULLMAN, MD: It wasn't appreciated until the 1980s that patients with Crohn's disease were at an increased risk as well. This is because patients with Crohn's disease don't necessarily have disease in the colon. It turns out that probably patients with Crohn's disease are at an equivalent risk for developing colon cancer as patients with ulcerative colitis provided that they have a similar duration of disease and a similar extent of colon involved.

ANNOUNCER: Within the population of people with IBD, there are other risk factors.

DAVID T. RUBIN, MD: The risks of cancer in inflammatory bowel disease include more extensive disease -- in other words, more of the bowel being involved -- longer duration of disease, people who have a family history of colon cancer independent of a family history of inflammatory bowel disease are at increased risk for cancer with their IBD, and a condition which causes inflammation of the bile ducts in the liver called primary sclerosing cholangitis appears to be an independent risk factor for cancer in inflammatory bowel disease. More recently, researchers have suggested that the degree of inflammation is an independent risk factor for cancer.

ANNOUNCER: Colonoscopies and biopsies of tissue samples taken from the colon are the main techniques used in surveillance for colon cancer, or for pre-cancerous conditions.

DAVID T. RUBIN, MD: The sequence of events that lead to cancer in inflammatory bowel disease are not the same as cancer in people who don't have inflammatory bowel disease. What we believe to occur is that inflammation leads to a precancerous state called dysplasia.

Dysplasia is not necessarily visible to the colonoscopist, and so the way we look for this is by doing random surveillance biopsies throughout the bowel and then have a pathologist carefully analyze those for dysplasia.

ANNOUNCER: When the pathologist returns a report of dysplasia, many doctors recommend having the colon removed, regardless of how early or advanced are the cellular changes.

STEVEN H. ITZKOWITZ, MD: If an expert pathologist tells you it's high-grade dysplasia, there's a very strong likelihood that there may already be cancer in the colon at that time or in the near future. The likelihood may be anywhere from 45 to 65 percent, in several studies. So, if high-grade dysplasia is found, most physicians would recommend that the colon should come out because of the high risk of either a coincidental colon cancer at that time or a subsequent colon cancer.