Neoplastic risk for liver and colon in primary sclerosing cholangitis

Primary sclerosing cholangitis (PSC) is a rare disease that may well be notified as a premalignant condition due to the increased cancer risk. The risk is highest for hepatobiliary cancer and increased by 28-398 times compared to the general population. When comorbidity with inflammatory bowel disease exists, the risk for colorectal cancer is increased 5-12 times and may even be higher after liver transplantation. The cancer risk estimates have decreased with time but vary according to study design. More recent population-based studies have approximated lower cancer risk than previous studies. Higher awareness and earlier detection of PSC together with increased surveillance over time may have influenced risk estimates. Surveillance for PSC patients is recommended for early tumor detection in both the liver and colon to enable curative treatment. The evidence for the efficacy of surveillance for early detection of hepatobiliary cancer is weak and an accepted common strategy worldwide is lacking. The high risk of hepatobiliary cancers has been confirmed repeatedly and future studies in PSC should focus on individualizing follow-up strategies and treatment