Dysplasia in Ulcerative Colitis
Patients at highest risk for developing cancer in ulcerative colitis are those with 'extensive' or total involvement of the large bowel who have had the disease for at least seven years. Dysplasia is used as a marker bur has many problems including those of sampling, reproducibility and ma...
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| Main Author: | |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
1990-01-01
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| Series: | Canadian Journal of Gastroenterology |
| Online Access: | http://dx.doi.org/10.1155/1990/713861 |
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| Summary: | Patients at highest risk for developing cancer in ulcerative colitis
are those with 'extensive' or total involvement of the large bowel who have had
the disease for at least seven years. Dysplasia is used as a marker bur has many
problems including those of sampling, reproducibility and management. The
risk in patients with colitis is unclear particularly in those with left-sided or distal
ulcerative colitis. In countries at high risk from colorectal cancer about 4 to 6%
of the population can be expected to develop this disease. It is assumed that
surveillance will reduce the mortality from colorectal cancer, although the
evidence that this is happening is very limited. Cancers which are resected but
from which the patient survives are an acceptable outcome, although less so in
theory, as survival is to a certain extent fortuitous. Many surveillance studies
include patients who have both developed and died from carcinoma. Surveillance
also assumes that cancers can be detected before they have become lethal,
or that a marker such as the presence of dysplasia precedes all carcinomas for a
long enough period of time to be detectable. Considerable question has been
raised as to whether dysplasia is both endoscopically detectable and morphologically
identifiable. Surveillance is based on the principle that carcinoma arises
from a cancerous lesion, and that the identification of dysplasia and excision of
the large bowel in these patients prevents subsequent death from disseminated
carcinoma. Conversely, patients with quiescent disease and no dysplasia could
be followed and not subjected to unnecessary colectomy. There is currently no
'best' way of managing patients with colitis who are at risk for developing
carcinoma. Routine follow-up of patients relies heavily on colonoscopy with
multiple biopsies. Controversy continues regarding the management of dysplastic
biopsies because there are relatively few data regarding the likelihood of an
underlying invasive carcinoma on which to base a rational decision. The notion
that all patients must be managed on an individual basis, guarantees that data
remain difficult to obtain. The presence of a dysplasia-associated lesion or mass
are high risk factors for carcinoma. Dysplasia is frequently confined to small areas
of the mucosa causing major sampling problems for the endoscopist both in
detection and if confirmation by re-endoscopy is proposed. The finding of
aneuploidy as a marker for both dysplasia and carcinoma may prove useful in
the detection of patients at greatest risk. |
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| ISSN: | 0835-7900 |