Intestinal cancers occurring in patients with Crohn's disease (original) (raw)
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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).
Intestinal cancer risk and mortality in patients with Crohn's disease
Gastroenterology, 1993
It is important to know about mortality, risk of intestinal cancer, and surgical intervention as well as possible predictive factors for patients with Crohn's disease. These prognostic parameters were estimated by regular follow-up of a complete, regional incidence cohort of 373 patients. Methods: Annual assessments of clinical conditions were the basis for statistical evaluation with life table analysis, calculations of relative risk, and lifetime cancer risk. Results: Survival curves for the total group of patients with Crohn's disease and the background population did not differ. However, a subgroup of patients aged 20-29 years at diagnosis (P = 0.04) and a subgroup of patients with extensive small bowel disease (P = 0.03) showed slightly increased mortality within the first 5 years. Cancer in small and/or large bowel occurred in 3 patients vs. an expected 1.8(P = NS). Small bowel cancer was found in 2 patients vs. the 0.04 expected (P = 0.001). Lifetime risk of intestinal cancer was 4.1% compared with 3.8% for the Danish population in general (P = NS). Probability of surgical resection within 15 years after diagnosis was 70%. The initial extent of disease significantly influenced the probability for resection, which was 78% in ileocecal enteritis and 44% in all other localizations within 5 years after diagnosis. Conclusions: The overall mortality and lifetime risk of cancer in patients with Crohn's disease was not found increased, although the risk of rare small bowel cancer was significantly increased. MUNKHOLM ET
Patterns of neoplasia in Crohn's disease and ulcerative colitis
Cancer, 1980
Cancer occurred in 28 of 579 patients (4.8%) with Crohn's disease (CD) and in 30 of 267 (11.2%) with ulcerative colitis (UC) admitted to the Mount Sinai Hospital between 1960-1976. The proportion of cancers that were extraintestinal was greater in CD than in UC (43 vs. 12%), as was the proportion of gastrointestinal cancers that arose in apparently normal bowels (33 vs. 4%). The incidence of gastrointestinal cancer increased with duration of disease in both CD and UC, but the absolute rates were three times higher in UC. For extraintestinal cancer, on the other hand, there was less correlation with increasing duration of disease, and no higher frequency in UC than in CD. Mortality from gastrointestinal cancer was 82% in CD and 50% in UC, but occurred only within two years of tumor diagnosis; survival beyond two years seemed to indicate a favorable prognosis.
A comparison of cancer risk in crohn's disease and ulcerative colitis
Cancer, 1981
The authors estimated cancer risk among 579 patients hospitalized with Crohn's disease between 1960-1976 by calculating the ratios of observed number of cancers (0) in our hospital sample to the expected number of cancers (E) based on the age-and sex-specific cancer rates of a standard population. The authors then compared these O/E ratios with the O/E ratios similarly calculated among 267 patients hospitalized with ulcerative colitis. The risk of colorectal cancer was significantly increased in Crohn's disease (O/E = 6.9, P < 0.001). This increase was similar in magnitude to that found in left-sided ulcerative colitis (O/E = 8.6, P < 0.001) but was much less than that found in universal ulcerative colitis (O/E = 26.5, P < 0.001). The incidence of small bowel cancer was greatly increased in the combined group of regional enteritis and ileocolitis (O/E = 85.8, P < 0.001), and even more so in the regional enteritis group alone (O/E = 114.5, P < 0.001). The incidence of extraintestinal cancer did not increase in any of the patient groups.
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.
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.
Colorectal cancer in Crohn’s disease: a series of 6 cases
Surgical Case Reports, 2021
Background Colorectal cancer (CRC) is the most malignant complication in patients with Crohn’s disease (CD). We report 6 cases of CD-related CRC treated surgically at our hospital. Case presentation From 2010 to 2016, six CD patients were diagnosed with CRC. All patients were diagnosed with CD at 10 years (range, 15–42 years) in all patients. The histological type of cancer was mucinous carcinoma in two cases, well-differentiated tubular adenocarcinoma in two cases, and moderately differentiated tubular adenocarcinoma in two cases. CRC was detected by screening colonoscopy in three cases (50%), and from clinical symptoms in the remaining three cases (50%). Two cases underwent colonoscopy within 2 months after symptom onset, detecting CRC in the relatively early stage. However, one case was diagnosed with advanced-stage CRC by endoscopy 1 year after symptom onset, and experienced poor prognosis. Conclusions Regular surveillance colonoscopy is needed to detect early-stage CRC in CD p...
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.