The risk for squamous-cell carcinoma of the anus is not increased in patients with perianal Crohn's disease [15, 35]. The presence of inflammation may delay the diagnosis of cancer, so in any patients with persistent perineal ulcers or fissures that fail to heal, a biopsy of the lesion should be considered. An association exists between colorectal cancer and Crohn's disease. . A long duration of illness and the presence of chronic perianal disease may increase the risk for rectal malignancy [15, 37-39]. The risk for colorectal cancer is not confined just to areas of inflammation; in addition the risk for rectal cancer may be increased if the rectum has been excluded from intestinal flow or placed out of intestinal continuity. This is similar to the increased cancer risk in bypassed segments of small bowel [38, 40]. Lavery and Jagel-man  identified two cases of cancer that developed in the out-of-circuit rectum after subtotal colectomy and colostomy for Crohn's disease. Because of this risk, such patients require cancer surveillance or proctectomy.
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