Intestinal cancer in Crohn's disease.

AIMS

We investigated Crohn's Disease (CD) patients with carcinomas in the intestinal tract to emphasize the difficulty in establishing a diagnosis, as well as show the importance of establishing formal guidelines for screening and surveillance of cancers associated with perianal CD.

METHODOLOGY

We studied 504 CD patients treated in our department with surgical intervention.

RESULTS

In 9 of the patients, carcinomas developed in relation to CD, 7 of whom had cancer of the lower rectum and anus with severe anorectal CD lesions. Five of 6 patients with advanced carcinoma in the anorectal region were treated using preoperative chemoradiation therapy and all 7 with anorectal carcinomas underwent an abdominoperineal resection. Two patients with a carcinoma of the fistula in the ileo-rectum or ileo-sigmoid colon were treated by a partial resection of the small and large bowel with the fistula. Mucinous cell type carcinomas were present in 6 patients, while signet ring cell type was found in 2 patients and poorly differentiated adenocarcinoma in 1. Three died prior to the follow-up examination.

CONCLUSIONS

There was an increased incidence of carcinoma in the intestinal tracts of patients with CD. It is important to establish a surveillance program for CD patients, especially those complicated with severe anorectal CD lesions.