Intestinal cancer risk and mortality in patients with Crohn's disease (original) (raw)
Related papers
Gut, 1985
All patients in the county of Copenhagen (approximately 500 000 inhabitants) with Crohn's disease, n= 185 were followed regularly between 1960 and 1978. The survival, the course of disease, the frequency of surgery, and the working capacity were estimated for the first 10 years of disease on the basis of the follow up results. The observation time ranged from 1-18 years with a median of 5 5 years for clinical observations, 5 8 years for survival, and 9-5 years for the occurrence of gastrointestinal cancer. The follow up was 100% concerning survival and cancer. The survival did not differ from that of the age-and sex-matched background population. Cancer was seen in only one of 185 patients corresponding to an annual risk of 0 06% and a cumulated risk after 10 years of 0 56, 95% confidence limits: 0 1-3 1%. The cancer was localised in the ileum. For all years, about 45% of the patients were without clinical symptoms of their disease, in 30% the clinical disease activity was low, and in 25% moderate to high. Among the patients with active disease, the course within the individual year was continuous in about one third and intermittent in about two thirds. After 10 years, 99% of the patients had experienced at least one relapse. The operation rate was 33% in the year of diagnosis, 13% in the following year, and then about 3% per year independent of whether or not the patient had been treated surgically in the past. After 10 years, 45% of the patients had not been treated surgically, 42% had had only one operation, and 13% had had two or more operations for their Crohn's disease. The working capacity was normal in about 75% of the patients for all years except the year of diagnosis. About 15-20% of the patients who had had the disease for more than five years were disabled as compared with about 4X4% of the background population. These results indicate that some of the patients with Crohn's disease run a more serious course with continuing symptoms despite of 'medical treatment and frequent surgical interventions. Most patients, however, remained capable for work and were able to lead a normal life.
Journal of Crohn's and Colitis, 2011
Background and aims: Limited data are available on the incidence and predictors of colorectal (CRC) and small bowel adenocarcinoma (SBA) in patients with Crohn's disease (CD) from population-based cohorts. Since data are completely missing from Eastern Europe, our aim was to analyze the incidence and risk factors of CD associated CRC and SBA in the population-based, Veszprem province database, which included incident patients diagnosed between January 1, 1977 and December 31, 2008. Methods: The data of 506 incident CD patients were analyzed (age-at-diagnosis: 31.5, SD: 13.8 years). Both hospital and outpatient records were collected and comprehensively reviewed. Results: CRC was diagnosed in five patients (5/5758 person-year-duration) during follow-up, while no patients developed SBA in this cohort. Standardized incidence ratio (SIR) of CRC was not increased overall with five cases observed vs. 5.02 expected (SIR: 0.99, 95% CI: 0.41-2.39); however, there was a tendency for increased incidence in males (five cases observed vs. 2.56 expected; SIR: 1.95, 95% CI: 0.81-4.70). Age at onset of CD (p b 0.001), male gender (p = 0.022
Journal of Gastrointestinal Surgery, 2010
Background Late diagnosis of cancer in CD often occurs, and the prognosis is poor. The primary aim of this study was to assess the relationship between clinical presentation and diagnosis of intestinal adenocarcinoma in CD; the secondary aim was to evaluate the timing of cancer occurrence in CD patients. Patients and methods Medical records of 12 consecutive patients with intestinal adenocarcinoma in CD and of 79 consecutive CD patients undergoing bowel surgery were reviewed. Presentation symptoms were analyzed as possible predictors. Timing of intestinal adenocarcinoma occurrence in patients with CD was analyzed including all the 347 consecutive patients that had undergone surgery for CD in our institute from January 1984 to June 2008. Life table analysis and uni/multivariate analyses were performed. Results Ten men and two women underwent surgery for intestinal cancer in CD with a median age of 50 years (31-68). Carcinomas were localized in the terminal ileum in four cases, right colon in three, transverse colon in one, sigmoid colon in one, rectum in two, and an anorectal fistula in one. Only three patients were pre-operatively diagnosed with cancer. At multivariate analysis only age (OR 1.057 (95% CI 0.999-1.107), p=0.05) and obstruction (OR 6.530 (95% CI 1.533-27.806), p=0.01) significantly predicted cancer diagnosis. The risk rate (RR) for cancer occurrence started to rise at the end of the third decade of life (RR=0.005). The analysis of risk rate for cancer occurrence during overt CD showed that it is initially high at onset (RR=0.001) and after two other peaks at 150 months from onset, it began to rise again. The presence of Crohn's colitis was associated to a significant risk of cancer (HR= 4.790, p=0.009) while the use of 5-ASA resulted to be a protective factor against cancer occurrence (HR=0.122, p=0.013).
Meta‐analysis: colorectal and small bowel cancer risk in patients with Crohn's disease
Alimentary Pharmacology & Therapeutics, 2006
SummaryBackground Crohn's disease is associated with small bowel cancer whilst risk of colorectal cancer is less clear.Aim To ascertain the combined estimates of relative risk of these cancers in Crohn's disease.Methods MEDLINE was searched to identify relevant papers. Exploding references identified additional publications. When two papers reviewed the same cohort, the later study was used.Results Meta‐analysis showed overall colorectal cancer relative risk in Crohn's disease as 2.5 (1.3–4.7), 4.5 (1.3–14.9) for patients with colonic disease and 1.1 (0.8–1.5) in ileal disease. Meta‐regression showed reduction in relative risk over the past 30 years. Subgroup analysis showed Scandinavia had significantly lower colorectal cancer relative risk than the UK and North America. Cumulative risk analysis showed 10 years following diagnosis of Crohn's disease relative risk of colorectal cancer is 2.9% (1.5%–5.3%). Meta‐analysis showed small bowel cancer relative risk in C...
Crohn's Disease and Malignancies-An Update Journal of Clinical Trails in Oncology
Citation: Rosario Fornaro, et al. (2017) Crohn's Disease and Malignancies-An Update. J Clin Trials Oncol 1: 1-10. Abstract Background: Patients with Crohn's disease have a higher risk of cancer of the gastrointestinal tract and hematopoietic system compared with that of the general population. Identifying the most vulnerable groups of patients could be useful for planning appropriate screening methods. Methods: In order to identify how the risk of cancer, in patients with Crohn's disease, had changed in the last years, a literature search was conducted using Medline, PubMed, Science Direct. All the published studies on Crohn's disease and the risk of developing malignancies were identified using the following keywords: " Colorectal cancer and inflammatory bowel disease " , " Malignancies in IBD patients and risk factors " , " Crohn's disease and colorectal cancer " , " Crohn's disease and malignancies ". Results: In patients with Crohn's disease the risk of colorectal cancer is increased. This risk is more pronounced for the cancer of the colon, while the risk of cancer of the rectum is rather similar to that of the general population. Factors associated with a higher risk of colorectal cancer are: first diagnosis of Crohn's disease before 25 years of age, disease duration, severity of colitis, a family history of colorectal cancer, cigarette smoking, immunosuppressive therapy. The risk of cancer of the small intestine would be increased; this risk remains, however, delineated in absolute terms. Patients with Crohn's disease present, lastly, an increased risk of lymphoma, but this evidence could be undermined by various factors, such as immunosuppressive therapy. Conclusions: In patients with Crohn's disease has documented an increased risk of colon cancer, small intestine cancer, extra-intestinal tumours and lymphomas. The risk of developing a colorectal cancer is particularly high in patients with severe disease extended to the colon, especially if it arose at a young age. These patients are therefore candidates for surveillance with repeated colonoscopies.
Small bowel carcinoma in crohn's disease. Distinguishing features and risk factors
Cancer, 1989
An 86-year-old woman who developed small bowel adenocarcinoma 40 years following in-continuity bypass of a 60-cm segment of regional ileitis represents the 22nd reported patient with this complication of bypassed Crohn's disease. Her case demonstrates several of the typical clinical features of such cancers: late recrudescence of disease following a 40-year period of relative quiescence; delayed diagnosis due to misinterpretation of the clinical picture (intestinal obstruction, abdominal mass, intraabdominal abscess, and fistula formation) as due to inflammatory bowel disease; and an exceedingly poor prognosis with rapid widespread local dissemination and death. Histologically, severe dysplasia was demonstrated both in close proximity to and at a distance from the lesion. The increasing number of case reports of adenocarcinoma arising at the site of long-standing Crohn's disease, many with dysplasia within areas of diseased bowel, is further evidence that Crohn's disease is a precancerous condition. Physicians must continue to search for methods of earlier diagnosis to improve the prognosis of small bowel carcinoma in Crohn's disease.
Intestinal cancers occurring in patients with Crohn's disease
Journal of Gastroenterology and Hepatology, 2012
The number of patients with Crohn's disease (CD) and the number of cases of intestinal cancer associated with CD have both been increasing in Japan. However, the number of reported cases is lower than for ulcerative colitis-associated cancer. The aim of this study was to identify the clinical picture of CD-associated intestinal cancer in a consecutive series of patients with CD and to stress the importance of surveillance. Methods: We enrolled 174 consecutive patients (130 men, 44 women, mean age 25 years) diagnosed with CD and investigated the development of intestinal cancer from October 1998 to July 2010. There were 104 cases of the ileocolitis type, 47 of ileitis, and 23 of colitis. Results: Intestinal cancer developed in two male patients (1.5% of the total), whose respective ages at onset of CD were 41 and 19 years, and 55 and 37 years at onset of cancer. Both cases were of ileocolitis-type CD; one cancer developed in the rectum and the other in the small bowel, and both were accompanied by severe stricture. Histopathological results revealed well and moderately differentiated adenocarcinoma, respectively. Conclusions: Intestinal cancer developed in patients with ileocolitis-type CD of more than 10 years' duration. Our findings suggest that patients with chronic, widespread CD should be under cancer surveillance.
Diseases of the Colon & Rectum, 1992
Carcinoma of the colon that arises in patients with Crohn's disease is being reported with increasing frequency. To help clarify the nature of this association, records of 25 patients with Crohn's disease and colorectal carcinoma seen from 1957 through 1989 were reviewed. One patient had leiomyosareoma of the rectum, and two patients had the onset of Crohn's disease after the diagnosis and treatment of colorectal carcinoma. Therefore, 22 patients were available for complete retrospective analysis. The median age at diagnosis of Crohn's disease was 37 years (range, 15-67 years), and the median age at diagnosis of carcinoma was 54.5 years (range, 32-76 years). The median duration of symptoms preceding the discovery of colorectal carcinoma was 18.5 years (range, 0-32 years), Carcinoma arose in colonic segments with known Crohn's disease in 77 percent of patients, and six patients (27 percent) had associated colonic mucosal dysplasia. One lesion was classified as Dukes A, nine lesions were Dukes B, five lesions were Dukes C, and seven lesions were Dukes D. Patients with an onset of Crohn's disease before the age of 40 years had primarily Dukes C or D lesions and consequently poor survival. Most patients presented with nonspecific signs and symptoms, with nothing to distinguish the activity of the Crohn's disease from the presence of colorectal neoplasm. Younger patients with long-standing Crohn's disease should be considered for colonic surveillance to permit earlier diagnosis and treatment of potential colorectal carcinoma.
Alimentary Pharmacology and Therapeutics, 2004
To determine the long-term risk of intestinal and extra-intestinal malignancies in Crohn's disease patients in Copenhagen County, Denmark. Methods: In Copenhagen County, a strictly populationbased cohort of 374 patients with Crohn's disease diagnosed between 1962 and 1987 was followed until 1997 in order to determine the long-term risk of intestinal and extra-intestinal malignancies. Information on cancer occurrence was provided by the Danish National Cancer Registry and confirmed by the examination of hospital files. The observed number of cases was compared with the expected number, calculated from individually computed person-years at risk and 1995 cancer incidence rates for the background population.