From the Guidelines
For a 38-year-old female with ulcerative colitis (UC) for 6 years who has a perianal lesion, cancer screening colonoscopy should begin after 8 years from UC diagnosis, with subsequent surveillance every 1-3 years for dysplasia, as recommended by the most recent and highest quality study 1. This timing is based on the risk of colorectal cancer in UC patients increasing significantly after 8-10 years of disease duration, particularly in those with extensive colitis. Key factors influencing the risk include disease duration and extent, as highlighted in earlier studies 1. The presence of a perianal lesion warrants attention but doesn't alter the standard screening timeline. During these surveillance colonoscopies, multiple biopsies should be taken throughout the colon to detect dysplasia, which is a precursor to colorectal cancer. The frequency of follow-up colonoscopies depends on risk factors such as:
- Disease extent
- Family history of colorectal cancer
- Presence of primary sclerosing cholangitis
- Findings from previous examinations Earlier screening is not necessary at the time of diagnosis unless there are concerning symptoms, and the presence of mild inflammation does not change the recommended screening timeline, as supported by the consensus in the management of ulcerative colitis 1. It's crucial to consider the individual's risk profile to prevent the development of interval carcinomas, adjusting the monitoring interval accordingly, as suggested in the guidelines for endoscopic surveillance and management of colorectal dysplasia in inflammatory bowel diseases 1.
From the Research
Cancer Screening in Ulcerative Colitis
- The patient has a known case of ulcerative colitis (UC) for 6 years and has a perianal lesion, prompting the question of when to perform a colonoscopy for cancer screening.
- According to the studies, surveillance colonoscopies for patients with UC are necessary to monitor for the development of cancer and its precursor, dysplasia 2, 3.
- The management of dysplasia in UC has been evolving, with higher resolution colonoscopes and advanced endoscopic techniques, such as chromoendoscopy, endoscopic mucosal resection, and endoscopic submucosal dissection 2.
Timing of Colonoscopy
- The studies do not provide a specific recommendation for the timing of colonoscopy based on the duration of UC diagnosis.
- However, one study suggests that colonoscopy should be performed after 8 years from UC diagnosis for dysplasia follow-up, with intervals of 1-3 years 4.
- Another study found that dysplasia is more common in the distal than proximal colon in UC surveillance, suggesting that endoscopists should consider taking a greater percentage of biopsies in these segments 5.
Visibility of Dysplasia
- One study found that dysplasia and colorectal cancer in UC are endoscopically visible in most patients and may be reliably identified during scheduled examinations 6.
- The study reported that 58.5% of dysplastic lesions and 80.0% of cancers were visible to the endoscopist, with per-patient sensitivities for dysplasia and cancer of 71.8% and 100%, respectively 6.
Recommendation
- Based on the studies, it is recommended that the patient undergo colonoscopy after 8 years from UC diagnosis, with intervals of 1-3 years for dysplasia follow-up, as stated in option C.
- Option C is the most appropriate choice, as it aligns with the study recommendations for dysplasia follow-up 4.