Murthy Sanjay K, Kuenzig M Ellen, Windsor Joseph W, Matthews Priscilla, Tandon Parul, Benchimol Eric I, Bernstein Charles N, Bitton Alain, Coward Stephanie, Jones Jennifer L, Kaplan Gilaad G, Lee Kate, Targownik Laura E, Peña-Sánchez Juan-Nicolás, Rohatinsky Noelle, Ghandeharian Sara, Meka Saketh, Chis Roxana S, Gupta Sarang, Cheah Eric, Davis Tal, Weinstein Jake, Im James H B, Goddard Quinn, Gorospe Julia, Loschiavo Jennifer, McQuaid Kaitlyn, D'Addario Joseph, Silver Ken, Oppenheim Robyn, Singh Harminder
Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada.
J Can Assoc Gastroenterol. 2023 Sep 5;6(Suppl 2):S83-S96. doi: 10.1093/jcag/gwad006. eCollection 2023 Sep.
Cancer is a major cause of morbidity and mortality among people with inflammatory bowel disease (IBD). Intestinal cancers may arise as a complication of IBD itself, while extra-intestinal cancers may arise due to some of the immunosuppressive therapies used to treat IBD. Colorectal cancer (CRC) and small bowel cancer risks remain elevated among persons with IBD as compared to age-and sex-matched members of the general population, and the lifetime risk of these cancers is strongly correlated to cumulative intestinal inflammatory burden. However, the cumulative risk of cancer, even among those with IBD is still low. Some studies suggest that IBD-CRC incidence has declined over the years, possibly owing to improved treatment standards and improved detection and management of early neoplastic lesions. Across studies of extra-intestinal cancers, there are generally higher incidences of melanoma, hepatobiliary cancer, and lung cancer and no higher incidences of breast cancer or prostate cancer, with equivocal risk of cervical cancer, among persons with IBD. While the relative risks of some extra-intestinal cancers are increased with treatment, the absolute risks of these cancers remain low and the decision to forego treatment in light of these risks should be carefully weighed against the increased risks of intestinal cancers and other disease-related complications with undertreated inflammatory disease. Quality improvement efforts should focus on optimized surveillance of cancers for which surveillance strategies exist (colorectal cancer, hepatobiliary cancer, cervical cancers, and skin cancers) and the development of cost-effective surveillance strategies for less common cancers associated with IBD.
癌症是炎症性肠病（IBD）患者发病和死亡的主要原因。肠道癌症可能作为IBD本身的并发症出现，而肠外癌症可能由于用于治疗IBD的一些免疫抑制疗法而出现。与年龄和性别匹配的普通人群相比，IBD患者患结直肠癌（CRC）和小肠癌的风险仍然较高，并且这些癌症的终生风险与累积肠道炎症负担密切相关。然而，即使在IBD患者中，癌症的累积风险仍然很低。一些研究表明，多年来IBD-CRC的发病率有所下降，这可能归因于治疗标准的提高以及早期肿瘤病变检测和管理的改善。在对肠外癌症的研究中，IBD患者中黑色素瘤、肝胆癌和肺癌的发病率普遍较高，乳腺癌或前列腺癌的发病率没有升高，宫颈癌的风险不明确。虽然一些肠外癌症的相对风险随着治疗而增加，但这些癌症的绝对风险仍然很低，鉴于这些风险而放弃治疗的决定应仔细权衡未充分治疗的炎症性疾病导致的肠道癌症和其他疾病相关并发症风险增加的情况。质量改进工作应侧重于对存在监测策略的癌症（结直肠癌、肝胆癌、宫颈癌和皮肤癌）进行优化监测，以及为与IBD相关的较罕见癌症制定具有成本效益的监测策略。
