Frequently Asked Questions About Colorectal Cancer & IBD | Crohn’s & Colitis Foundation

Frequently Asked Questions About Colorectal Cancer & IBD

CCFA's Chair of Professional Education, Tom Ullman, MD, Answers Frequently Asked Questions About Colorectal Cancer & IBD

Each year, in the United States, 147,000 new cases of colorectal cancer (CRC) are diagnosed and more than 57,000 people die from the disease -- making it the second-leading cause of cancer-related deaths in this country. People with Crohn's disease and ulcerative colitis are at a higher risk for developing CRC than the general population. CRC is highly treatable in the early stage, which is why it's important to recognize its signs and symptoms -- and why regular screenings and early detection are crucial.

Q1: What is the risk for IBD patients developing colon cancer?

Patients with ulcerative colitis or Crohn's disease involving the colon with longstanding colitis are at greater risk of developing colon or rectal cancer than the general population.  This risk is primarily shared by IBD patients with 1/3 or more of their colon involved and who have had the disease for more than 8 years.

Q2: Which IBD patients should be concerned about colon cancer? Can young IBD patients develop colon cancer?

Patients with longstanding colitis and those with 1/3 or more of their colon involved should be more concerned about colon cancer than other IBD patients. Other factors that medical research has shown increases the risk of colon and rectal cancer include:

  • patients who also carry a diagnosis of an inflammatory condition of the bile ducts called primary sclerosis cholangitis (PSC)
  • patients with a family history of colon or rectal cancer
  • patients with more inflammation noted over time

Patients who develop IBD at a younger age may be at an increased risk when they are older.  It is unusual for young patients with IBD to develop colon cancer while they are young.  As young IBD patients grow up, their risk is greater than their age-related peers who were not diagnosed with IBD when they were young.

Q3: If I'm in remission, do I have less of a risk of developing colon cancer?

Yes, being in remission means microscopic inflammation is likely lower so the risk of developing colon cancer and pre-cancerous changes—know as dysplasia—is also lower.

Q4: If I take my medicine as directed will I be less likely to develop colon cancer?

Medicine used to treat IBD can help reduce colonic inflammation and as indicated earlier, less microscopic inflammation likely lowers the risk of developing colon cancer. So, taking your medicine as directed is important to reducing the risk of colon cancer. Not all studies have shown this kind of "chemopreventive" effect (medicines used to prevent cancer), but it seems apparent that many of these medicines may not only lessen inflammation and inflammation-related pathways to cancer, but they may block other pathways to cancer as well.  There are other reasons to adhere to prescribed medicines, too, as showing up in your doctor's office seems to have an independent preventive effect, and getting scheduled and undergoing regular colonoscopies is probably the most important tool we have for avoiding colon cancer in IBD.

Q5: What are the signs of colon cancer in IBD patients?

The active signs of ulcerative colitis or Crohn's disease including weight loss, fatigue, blood in the stool and crampy abdominal pain can also be the signs of colon cancer.  So that's why undergoing regular colonoscopies is an important part of cancer prevention for IBD patients.

Q6: How often should patients with IBD undergo colonoscopy? Are there any other effective screening methods readily available to patients?

The CCFA Consensus Panel recommends that after living with disease for 8 years, IBD patients who have 1/3 or more of their colon involved should have a colonoscopy every 1-2 years. For patients with primary sclerosing cholangitis, these colonoscopies should begin as soon as IBD is diagnosed.  At these colonoscopies, gastroenterologists will take numerous biopsies to exclude the presence of precancerous changes (dysplasia). They will also have the opportunity to remove any pre-cancerous polyps that might develop that would otherwise have the opportunity to develop into colon or rectal cancer.  Most patients will then just come back in 1-2 years for a repeat colonoscopy, while a very small minority, about 0.5%, will need to undergo surgery to prevent further changes and cancer from developing.

Q7: What have recent studies found about the relationship between IBD and colon cancer?

Recent studies have increased our knowledge about this relationship:

  • First, there is now evidence that surveillance colonoscopies reduce the likelihood of developing colon cancer.  
  • Second, colon cancers appear to be happening less frequently in patients with IBD than had previously been shown.  This may be a function of less inflammation over time due to IBD medicines, surveillance colonoscopies, or other factors that we don't yet understand.  No matter what the reason, it's obviously good news. 
  • Finally we've found that, improved optics with our scopes and newer endoscopic methods that allow gastroenterologists to better views of the colon's surface has lead to more successful removal of small precancerous polyps and plaques might be making a difference in the likelihood of IBD patients developing cancer.  Obviously, this is all welcome news, and we all look forward to further developments.  For now, though, the best practical advice is to talk about this with your gastroenterologist, take your medicines as prescribed, undergo periodic colonoscopies as advised by CCFA's Consensus Panel, and stay posted.

For further information, call Crohn's & Colitis Foundation's IBD Help Center: 888.MY.GUT.PAIN (888.694.8872).

The Crohn's & Colitis Foundation provides information for educational purposes only. We encourage you to review this educational material with your health care professional. The Foundation does not provide medical or other health care opinions or services. The inclusion of another organization's resources or referral to another organization does not represent an endorsement of a particular individual, group, company or product.

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Published: May 1, 2009

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