Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands.
Best Pract Res Clin Gastroenterol. 2011 Apr;25 Suppl 1:S27-38. doi: 10.1016/S1521-6918(11)70007-5.
Patients with inflammatory bowel disease (IBD) have an increased risk of developing colorectal cancer (CRC). Risk factors are extent and severity of colonic inflammation, concurrent primary sclerosing cholangitis, and a positive family history of sporadic CRC. The chromosomal instability, microsatellite instability and hypermethylation pathways form the molecular background of IBD-related carcinogenesis, which is not different from sporadic CRC. The dysplasia-carcinoma sequence of IBD-related colorectal carcinogenesis makes patients suitable for endoscopic surveillance. In the future, new molecular biomarkers and endoscopic techniques may improve early detection of precursor lesions of IBD-related CRC. The potential of aminosalicylates and ursodeoxycholic acid as chemopreventive agents needs to be studied in randomized clinical trials. Patients with IBD who are being treated with thiopurines have a slightly increased risk of developing lymphoproliferative disorders, whereas patients with small bowel Crohn's disease have a high relative risk and a small absolute risk of developing small bowel adenocarcinoma.
炎症性肠病（IBD）患者发生结直肠癌（CRC）的风险增加。风险因素包括结肠炎症的范围和严重程度、同时存在原发性硬化性胆管炎、以及散发 CRC 的阳性家族史。染色体不稳定性、微卫星不稳定性和高甲基化途径构成了 IBD 相关致癌作用的分子背景，与散发 CRC 并无不同。IBD 相关结直肠致癌作用的异型增生-癌序列使患者适合进行内镜监测。未来，新的分子生物标志物和内镜技术可能会提高对 IBD 相关 CRC 前体病变的早期检测。需要在随机临床试验中研究氨基水杨酸盐和熊去氧胆酸作为化学预防剂的潜力。正在接受巯嘌呤治疗的 IBD 患者发生淋巴增生性疾病的风险略有增加，而患有小肠克罗恩病的患者发生小肠腺癌的相对风险高，但绝对风险小。
