From the Guidelines
Patients with Crohn's disease have a significantly increased risk of developing colorectal cancer, with a pooled standardized incidence ratio of 1.9 [95% CI: 1.4-2.5] compared to the general population. This risk is further increased in patients with extensive colitis and those who are diagnosed with Crohn's at a younger age, with a standardized incidence ratio of 6.4 [95% CI: 2.4-17.5] for patients diagnosed under the age of 30 1. The cumulative risk of cancer in Crohn's patients is 1%, 2%, and 5% after 10,20, and more than 20 years of disease duration, respectively.
Key factors that contribute to the increased risk of colorectal cancer in Crohn's patients include:
- Longer disease duration
- Extent of colitis
- Familial history of colorectal cancer
- Coexistent primary sclerosing cholangitis
- Degree and duration of inflammation 1.
It is essential for patients with Crohn's disease to undergo regular cancer screening, including colonoscopies, to detect any potential cancerous changes early on. Proctocolectomy is recommended as a treatment for Crohn's disease-associated colorectal cancer or high-grade dysplasia, while segmental colectomy followed by endoscopic surveillance may be considered in selected cases 1. Patients with Crohn's disease should also follow general cancer prevention strategies, such as avoiding tobacco, limiting alcohol, maintaining a healthy weight, and protecting their skin from excessive sun exposure.
In terms of treatment, patients with colorectal cancer in Crohn's disease should be operated on according to the principles of oncological surgery, including adequate lymphadenectomy 1. This approach helps ensure the best possible outcomes for patients with Crohn's disease who develop colorectal cancer. By prioritizing regular screening, maintaining disease remission, and following cancer prevention strategies, patients with Crohn's disease can reduce their risk of developing colorectal cancer and improve their overall quality of life.
From the Research
Risk of Cancer with Crohn's Disease
- Patients with Crohn's disease have an increased risk of colorectal cancer (CRC) compared to the general population 2, 3, 4, 5.
- The risk of CRC in patients with Crohn's disease is similar to that of ulcerative colitis 2, 4.
- Factors that increase the risk of CRC in Crohn's disease include:
- Crohn's disease also increases the risk of other types of cancer, including:
- Regular surveillance colonoscopies may permit earlier detection of CRC and improve prognosis 2, 5.
- The interval between surveillance colonoscopies depends on each patient's personal risk profile 2.
- Control of inflammation is pivotal to the prevention of CRC in Crohn's disease 4.
- Current therapies for Crohn's disease, such as azathioprine, may reduce the risk of CRC by controlling inflammation, but their impact on cancer risk is still being studied 4, 6.