Crohn’s Disease and Malignancies-An Update.

Background: Patients with Crohn’s disease have a higher risk of cancer of the gastrointestinal tract and hematopoietic system compared with that of the general population. Identifying the most vulnerable groups of patients could be useful for planning appropriate screening methods. Methods: In order to identify how the risk of cancer, in patients with Crohn’s disease, had changed in the last years, a literature search was conducted using Medline, PubMed, Science Direct. All the published studies on Crohn’s disease and the risk of developing malignancies were identified using the following keywords: “Colorectal cancer and inflammatory bowel disease”, “Malignancies in IBD patients and risk factors”, “Crohn’s disease and colorectal cancer”, “Crohn’s disease and malignancies”. Results: In patients with Crohn’s disease the risk of colorectal cancer is increased. This risk is more pronounced for the cancer of the colon, while the risk of cancer of the rectum is rather similar to that of the general population. Factors associated with a higher risk of colorectal cancer are: first diagnosis of Crohn’s disease before 25 years of age, disease duration, severity of colitis, a family history of colorectal cancer, cigarette smoking, immunosuppressive therapy. The risk of cancer of the small intestine would be increased; this risk remains, however, delineated in absolute terms. Patients with Crohn’s disease present, lastly, an increased risk of lymphoma, but this evidence could be undermined by various factors, such as immunosuppressive therapy. Conclusions: In patients with Crohn’s disease has documented an increased risk of colon cancer, small intestine cancer, extra-intestinal tumours and lymphomas. The risk of developing a colorectal cancer is particularly high in patients with severe disease extended to the colon, especially if it arose at a young age. These patients are therefore candidates for surveillance with repeated colonoscopies.