Inflammatory bowel disease and colorectal cancer and their treatment

Colorectal cancer is one of the most devastating complications of chronic colitis in the setting of inflammatory bowel disease (IBD).1 Current strategies in the reduction or management of colitis-associated colorectal cancer are chemoprophylaxis, colonoscopy surveillance of at-risk individuals and proctocolectomy is a potentially curative treatment for those with precancerous dysplasia or early cancer. Maintaining colitis in remission may reduce colorectal carcinogenesis in IBD. 5-aminosalicylic acid compounds may have additional chemoprophylactic effects and ursodeoxycholic acid reduces colorectal carcinogenesis in the setting of primary sclerosing cholangitis. Antitumour necrosis factor agents and thiopurine analogues may not only treat colitis but also have chemoprophylactic benefits. New endoscopic imaging techniques, such as chromoendoscopy, may improve the yield of identifying flat dysplasia during surveillance colonoscopy. This chapter summarises the epidemiology of dysplasia in IBD, its classification, and outlines the current endoscopic surveillance strategies, treatment algorithm and dysplasia chemoprophylaxis.