S. Sunkara, G. Swanson, C. Forsyth, A. Keshavarzian
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Chronic Inflammation and Malignancy in Ulcerative Colitis
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.