Area Editoriale
The diagnosis and management of colorectal cancer in patients who have inflammatory bowel disease (IBD) is fraught with challenges and the subject is not without controversy. Optimal management requires a thorough knowledge of both diseases as well as the benefits and limitations of colonoscopic surveillance, careful IBD control, high-quality colonoscopy, robust surveillance booking mechanisms, empathic patient education and excellent communication across the multidisciplinary team looking after the patient. Make a mistake and your patient might be subjected to unnecessary life-changing surgery or exposed to an avoidably high lifetime risk of cancer.
Here, discussion about mistakes that are often made when managing patients undergoing colitis surveillance.
The discussion is evidence based, but where evidence is lacking, the discussion is based on personal experience of more than 20 years in the field.
Mistake 1: Forgetting that people with IBD have an increased risk of CRC.
Mistake 2: Assuming the CRC risk is the same for all people who have IBD and not following colitis surveillance guidelines recommendations.
Mistake 3: Selecting an inexpert endoscopist to perform colitis surveillance colonoscopies.
Mistake 4: Failing to optimise conditions for high-quality endoscopic surveillance.
Mistake 5: Producing a colonoscopy report that is not sufficiently detailed.
Mistake 6: Not obtaining a second, expert histopathologist opinion when dysplasia is detected.
Mistake 7: Assuming that endoscopic therapy in patients who have colitis is easy.
Mistake 8 Focusing on the lesion rather than managing the patient holistically.
Risk factors for colorectal neoplasia
• Primary sclerosing cholangitis
• Factors relating to inflammation
• Increasing severity of inflammation
• Extensive colitis
• Longer duration of disease
• Endoscopic features of previous severe or chronic active inflammation, including post-inflammatory polyps, strictures and shortened, tubular colonic appearance
• Previous colorectal neoplasia
• Family history of CRC in a first-degree relative, especially if <50 years old
Other possible risk factors
• Male sex
• Young age at IBD onset (probably a composite [non-independent] risk factor)