Dysplasia in inflammatory bowel disease Richa Shukla Faculty
mentors: Dr. Joseph Sellin and Dr. Jason Hou April 30, 2015
Slide 2
HPI 67M with history of ulcerative colitis Diagnosed >20
years ago while living in Mexico, treated only with Asacol
Presented to BTGH with symptoms of UC flare in 2012 colonoscopy in
5/2012 showed evidence of pancolitis Treated with prednisone taper
and transitioned to maintenance therapy with weight based
azathioprine 100 mg daily and Lialda
Slide 3
Colonoscopy 2/2015 Polypoid area in transverse colon CHRONIC
FOCALLY ACTIVE COLITIS WITH LOW- GRADE DYSPLASIA Sigmoid colon
polyp 1.5 cm, biopsied TUBULAR ADENOMA Random colonic and rectal
biopsies chronic active colitis with low grade dysplasia
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Colon, Transverse, polypoid lesion : LGD
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Rectum Bx: LGD
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Colon sigmoid, polyp: TA
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Algorithmic approach to the treatment of dysplasia in patients
with inflammatory bowel disease (IBD). DALM, Dysplasia-associated
lesion or mass.
Ulcerative colitis and colorectal cancer Risk of CRC depends
upon extent and duration of disease Greatest risk of cancer:
disease extending to the hepatic flexure or more proximally
>19000 patients followed for 35 months Longstanding and
extensive colitis (LEC) had increased risk for CRC compared with
general population (HR 7.0) Without LEC, risk was equivalent to
general population (HR 1.1) Beaugerie et al. Gastroenterology. 2013
Jul;145(1):166-175.e8
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Ulcerative colitis and colon cancer Risk increases 8-10 years
after symptom onset Incidence of colon cancer in patients with
pancolitis estimated at 5-10% after 20 years of disease, 12-20%
after 30 years Mir-Madjlessi SH et al Cancer. 1986;58(7):1569.
Eaden JA et al Gut. 2001 Apr;48(4):526-35.
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UC, PSC and risk of colon cancer Increased risk of cancer in
patients with UC and PSC Historical cohort study of 132 patients
with UC and PSC: 33 (25%) developed cancer or dysplasia v. 11
(5.6%) of 196 control patients (UC without PSC) Right sided cancer
more common 17 cancers in PSC group 76% were proximal to splenic
flexure, 35% advanced stage v. control group with 1/5 proximal and
none advanced stage Possible role of bile acids in oncogenesis
Shetty K et al Am J Gastroenterol. 1999;94(6):1643.
Slide 15
Crohns disease and CRC StudyLocationNumber of patients Risk of
CRC Van den Heuvel et alNetherlands1162 patients33% increased risk
of developing CRC as compared with general population Ekbom et
alSweden1655 patients-RR 2.5 for CRC -RR 5.6 for colonic disease
-RR 21 for those diagnosed
