Colorectal cancer in Ulcerative Colitis: A prospective study of clinical and biological markers in population based cohorts

A significant number of IBD patients still develop colitis associated colorectal cancer (CACRC). Guidelines, therefore, recommend colonoscopic surveillance at intervals based on a patient´s individual risk determined by clinical risk factors. To improve the detection of lesions, high definition (HD) colonoscopy or dye-enhanced colonoscopy, chromoendoscopy (CE) are advised. However, the current risk of CA-CRC in Norway is unknown. Moreover, colonoscopic surveillance is not systematically implemented, and CE is not widely applied for the surveillance of IBD patients in Norway. The purpose of the study was to examine the overall risk of CA-CRC and the association to clinical risk factors in a Norwegian population-based inception cohort of ulcerative colitis (UC) patients. Furthermore, the implementation of CE in everyday practice in a community hospital, and the efficacy of non-invasive multitarget stool DNA tumour markers (MTsDNA). The study found that although surveillance colonoscopy was not systematically performed, the risk of CA-CRC in UC was low and comparable to the risk of CRC in the background population of Norway. Chromoendoscopy appeared to be of value for dysplasia surveillance of UC in a community hospital setting. The yield of non-targeted biopsies was negligible. The MT-sDNA panel detected CA-CRC. Sensitivity for sub-centimeter colorectal neoplasms in IBD patients, appeared similar to that observed in the non-IBD population