Neoplasms in Ulcerative Colitis

Abstract

Patients with Ulcerative Colitis have an increased risk of developing colorectal carcinoma, which is related to the cumulative effect of chronic inflammation, and correlates directly with the duration and extent of colonic disease and with histological severity. Additional factors that contribute to the individual cancer risk include early age at disease onset, coexistent sclerosing cholangitis and family history of colorectal cancer. Although with some limitations, surveillance colonoscopy represents the cornerstone of prevention and early diagnosis. High grade dysplasia and cancer are indications for prophylactic colectomy. Cross-sectional diagnostic imaging, particularly with multidetector CT, allows identification of features suspected for colorectal cancer in patients investigated for inflammatory bowel diseases. Water enema multidetector CT colonography is helpful to investigate UC patients with suspicious endoscopic changes, detection of colonic neoplasms, or an impassable stricture, and represents an extremely reliable technique to detect and comprehensively stage colorectal cancer. Exceptionally, anal tumours may occasionally develop in patients with ulcerative colitis-related chronic perianal inflammation. MRI is the imaging modality of choice to stage rectal and anal carcinomas, and for assessment of therapeutic response following radio-chemotherapy.