How is the risk of adenocarcinoma monitored in patients with ulcerative colitis (UC)?

Updated: Apr 01, 2019
  • Author: E Stanton Adkins, III, MD; Chief Editor: Harsh Grewal, MD, FACS, FAAP  more...
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Answer

Answer

Colonic dysplasia is a precursor to adenocarcinoma and occurs in patients with UC.

Many physicians use surveillance colonoscopy for monitoring patients with UC and determining the need for colectomy. This involves scheduled annual or biannual colonoscopy with multiple random biopsies.

However, surveillance colonoscopy must be undertaken with caution, because even low-grade dysplasia is associated with synchronous adenocarcinoma in as many as 42% of cases, and as many as 84% of neoplasms in persons with UC are missed at random biopsy.

Furthermore, 1% of colon cancers in patients with UC have no foci of preexisting dysplasia. Even in patients in whom the disease is medically controlled, the optimal time for colectomy may be 7-10 years after the onset of disease, to prevent colon cancer. [6]

Historically, patients with UC had a 1% risk of colon adenocarcinoma per year after 8-10 years of disease. After 20 years of disease, the incidence of adenocarcinoma was as high as 25%. [7] However, data acquired after the advent of improved medical therapy suggested that the incidence of adenocarcinoma has decreased somewhat. Among 600 patients colonoscopically examined for 30 years, Rutter et al found that the cumulative risk of cancer was only 2.5% at 20 years, 7.6% at 30 years, and 10.8% at 40 years. [8]

Backwash ileitis is an independent marker for the presence of dysplasia, as is age older than 45 years and the presence of disease for more than 10 years. Therefore, the patient with UC must be made aware of the significant risk of colon cancer, and surgical intervention in nonacute cases must be encouraged after 10 years of disease.


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