Dysplasia and Cancer in Inflammatory Bowle Disease, An Issue of Gastroenterology Clinics

Cover......Page 1
Preface......Page 2
Epidemiology and Risk Factors for Colorectal Dysplasia and Cancer in Ulcerative Colitis......Page 5
Absolute Risk (Prevalence, Incidence, and Cumulative Probability)......Page 6
Relative Risk......Page 9
Incidence of colorectal dysplasia......Page 10
Duration of Inflammatory Bowel Disease......Page 11
Primary Sclerosing Cholangitis......Page 12
Severity of Chronic Bowel Inflammation......Page 14
Age at Ulcerative Colitis Diagnosis......Page 15
References......Page 16
Classification of dysplasia in inflammatory bowel disease......Page 20
Microscopic Features......Page 22
Negative for Dysplasia......Page 23
Indefinite for Dysplasia......Page 24
High-Grade Dysplasia......Page 25
Low-Grade Dysplasia Versus High-Grade Dysplasia......Page 26
Dysplasia in Crohn’s Disease......Page 27
Adjunctive Diagnostic Markers......Page 28
Pathologic features of elevated dysplasia in inflammatory bowel disease......Page 29
Pathologic features of carcinoma in inflammatory bowel disease......Page 33
References......Page 34
Causation: genes versus environment......Page 40
Molecular pathways of sporadic colon carcinogenesis......Page 41
Genomic instability and clonal expansion in inflammatory bowel disease......Page 42
Role of chronic inflammation in inflammatory bowel disease neoplasia......Page 43
Molecular pathways of colitis-associated colon carcinogenesis......Page 44
Chromosomal instability......Page 45
Aneuploidy......Page 46
P53 tumor suppressor gene......Page 47
Microsatellite instability......Page 48
Promoter methylation......Page 49
Markers of Cancer Progression......Page 50
Molecular Markers of Future Cancer Risk......Page 51
New molecular screening approaches......Page 52
References......Page 53
The incidence of dysplasia in ulcerative colitis......Page 59
The incidence of cancer after flat dysplasia is diagnosed......Page 60
The polypoid dysplastic lesion......Page 62
References......Page 64
Risk factors for colorectal cancer in ulcerative colitis......Page 66
Dysplasia......Page 68
Biomarkers of dysplasia......Page 70
Evidence for surveillance colonoscopy in ulcerative colitis......Page 71
What about Crohn’s disease?......Page 74
Technique of surveillance......Page 76
Approach to polypoid lesions in inflammatory bowel disease......Page 77
Putting it all together: current guidelines and consensus......Page 78
Do clinicians understand these guidelines?......Page 84
Summary......Page 85
References......Page 86
Detection of premalignant lesions in ulcerative colitis......Page 90
Reactive Dyes......Page 91
Examination Technique......Page 93
Efficiency of Chromoendoscopy......Page 95
Limitations of Chromoendoscopy and Magnifying Endoscopy......Page 96
Narrow band imaging......Page 97
Optical coherence tomography......Page 98
Confocal laser endomicroscopy......Page 99
Technique of Confocal Laser Endomicroscopy......Page 100
Clinical Data......Page 101
References......Page 103
Population- and hospital-based studies......Page 105
Risk factors: young age of onset......Page 106
Risk factors: duration of disease......Page 108
Screening and surveillance in chronic Crohn’s colitis......Page 109
Risk factors: colonic strictures......Page 110
Comparison of colorectal cancer in Crohn’s disease with ulcerative colitis......Page 112
Small bowel cancer in Crohn’s disease......Page 113
Cancers associated with perianal fistulae......Page 115
Lymphoma and leukemia in Crohn’s disease......Page 116
Squamous cell cancers and carcinoids......Page 117
References......Page 118
Surgical Approaches to Cancer in Patients Who Have Inflammatory Bowel Disease......Page 124
Indications for surgery......Page 125
Preoperative evaluation and staging......Page 127
Surgical Approaches......Page 129
Ulcerative Colitis......Page 130
Total proctocolectomy and ileostomy......Page 131
Total proctocolectomy with ileal pouch-anal anastomosis......Page 133
Surgical controversies of ileal pouch-anal anastomosis......Page 136
Outcomes and complications after ileal pouch-anal anastomosis......Page 138
Indeterminate Colitis......Page 140
Segmental resection......Page 141
Segmental resection......Page 143
Subtotal colectomy and ileorectal anastomosis......Page 144
Metastatic Disease......Page 145
Postoperative surveillance......Page 146
Prognosis and long-term outcomes......Page 148
References......Page 149
Chemoprevention: Risk Reduction with Medical Therapy of Inflammatory Bowel Disease......Page 157
Colorectal carcinogenesis in inflammatory bowel disease......Page 159
5-aminosalicylates......Page 160
Putative Mechanisms of 5-Aminosalicylates......Page 161
Epidemiologic Studies of 5-Aminosalicylates......Page 162
5-Aminosalicylates and Dysplasia Progression......Page 170
Corticosteroids......Page 171
Immunomodulators......Page 174
Ursodeoxycholic acid......Page 178
Folate......Page 182
Calcium......Page 186
Summary and recommendations......Page 187
References......Page 188
Systemic Treatment of Patients Who Have Colorectal Cancer and Inflammatory Bowel Disease......Page 195
Diagnostic challenges......Page 196
Chemotherapy......Page 197
Fluoropyrimidines......Page 198
Irinotecan......Page 200
Monoclonal Antibodies Against the Epidermal Growth Factor Receptor: Cetuximab and Panitumumab......Page 201
Mucosa-Protective Agents......Page 202
Summary......Page 203
References......Page 205