title: An update on cancer risk and surveillance in primary sclerosing cholangitis.
abstract: Malignancy represents substantial morbidity and mortality in patients with primary sclerosing cholangitis (PSC). This subset of patients has been proven to be at increased risk for developing cholangiocarcinoma, gallbladder carcinoma and colorectal cancer in those with overlapping inflammatory bowel disease. Herein, we review the prevalence of these malignancies and recommend screening tools and current knowledge to reduce the disease burden in this population. Cholangiocarcinoma is the most dominant malignancy affecting PSC patients, with a lifetime risk ranging from 5% to 20%. We advocate for serial US or MRI/MRCP and CA 19-9 to screen for cholangiocarcinoma. Gallbladder cancer has a lifetime risk around 2% in this population and we agree with annual imaging for lesions as recommended by national guidelines. Patients with PSC and concomitant IBD are at increased risk of colorectal carcinoma from time of diagnosis and therefore should likely undergo annual surveillance. The low rates of hepatocellular cancer and pancreatic cancer indicate surveillance for these malignancies is less advantageous.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Horsley-Silva
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, USA.
authors.forename: Eduardo A
authors.initials: EA
authors.lastname: Rodriguez
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, USA.
authors.forename: Diana L
authors.initials: DL
authors.lastname: Franco
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, USA.|College of Health Solutions, Arizona State University, Phoenix, AZ, USA.
authors.forename: Keith D
authors.identifier: 0000-0003-1046-5621
authors.initials: KD
authors.lastname: Lindor
mesh_terms: D015209:Cholangitis, Sclerosing / Q000150:complications / Q000453:epidemiology*; D004067:Digestive System Neoplasms / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D011159:Population Surveillance
keywords: cancer surveillance; cholangiocarcinoma; cirrhosis; colorectal cancer; gallbladder cancer; hepatocellular carcinoma; primary sclerosing cholangitis