Surveillance for cancer and dysplasia in inflammatory bowel disease.
There remain technical challenges to the accurate prediction and diagnosis of neoplasia in IBD; therefore, prevention strategies are based on limited evidence and instead, consensus opinions and guidelines. Existing guidelines and published expert opinions are in agreement that given the increased risk of cancer in IBD and well-described associated risks, prevention strategies are warranted. The preponderance of existing prevention is focused on secondary prevention by performance of screening and surveillance colonoscopies with random biopsies to identify neoplasia and trigger surgical resection for prevention of invasive cancer and death. Substantial technical and practical challenges remain, however, and there is a great need for improved understanding of the compounded risks of neoplasia, the natural history of dysplasia, and more accurate detection and diagnostic techniques. A future approach to prevention is likely to stratify patients based on individualized risks that include, among things, the histologic degree of inflammation present. In meantime, existing guidelines should be emphasized and ongoing education of clinicians and patients must occur.
Rubin
David T
DT
Section of Gastroenterology, and The MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL 60637, USA. drubin@medicine.bsd.uchicago.edu
Kavitt
Robert T
RT
D015415:Biomarkers; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D018450:Disease Progression; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D011159:Population Surveillance / Q000379:methods; D017410:Practice Guidelines as Topic; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors
D015415:Biomarkers