%0 Journal Article
%T Chronic Inflammation and Malignancy in Ulcerative Colitis
%A Sai Sunkara
%A Garth Swanson
%A Christopher B. Forsyth
%A Ali Keshavarzian
%J Ulcers
%D 2011
%I Hindawi Publishing Corporation
%R 10.1155/2011/714046
%X Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) associated with multiple colonic and extraintestinal complications, the most severe being the development of colorectal cancer (CRC). Compared to the general population, there is an increased risk of CRC associated with UC. Although the pathogenesis of CRC in UC is unknown, most studies have linked it to long-standing inflammation as well as other risk factors such as duration of disease, extent of inflammation, family history of CRC, and coexisting conditions such as primary sclerosing cholangitis (PSC). UC is a life-long disease for which patients enter a vigilant screening program which includes surveillance colonoscopy to promote early detection of CRC yet some controversies exist regarding the cost effectiveness of surveillance colonoscopy and improving survival. Newer modalities such as chromoendoscopy, narrow band imaging, high definition colonoscopy, and confocal microscopy have aided in developing a more targeted approach for early detection of dysplasia in surveillance colonoscopy. This review focuses on the role of chronic colonic inflammation and dysplasia in development of UC-associated CRC and current methods of screening, detection, chemoprevention, and treatment of UC-associated CRC. 1. Introduction Ulcerative Colitis (UC) is one of two types of inflammatory bowel disease (IBD) with disease limited to the colonic mucosa. The disease is associated with episodic periods of debilitating symptoms such as abdominal pain, rectal bleeding, fecal urgency, diarrhea, incontinence, and weight loss followed by asymptomatic intervals of remission. UC also is associated with extraintestinal manifestations such as uveitis, ankylosing spondylitis, erythema nodosum, and primary sclerosing cholangitis (PSC). The disease course in UC may be severe, but main contributors to morbidity and mortality is due to the increased risk of developing colorectal cancer (CRC) [1]. The incidence of CRC in the UC is approximately 4/1000 per person year duration with an average prevalence of 3.5% [2]. Currently, UC ranks third only behind familial adenomatous polyposis (FAP) and hereditary nonpolyposis colorectal cancer (HNPCC) as a high-risk condition for CRC [3]. While the exact pathogenesis behind the development of colitis related CRC has not been identified, studies have shown it is most likely a result of chronic inflammation that leads to progressive dysplasia and eventually adenocarcinoma. This neoplastic process typically begins after a long duration of disease of 8 to 10 years and it can occur
%U http://www.hindawi.com/journals/ulcers/2011/714046/