Risk of Carcinoma

Similar to ulcerative colitis, CD is a risk factor for development of colorectal cancer [75, 76]. The risk is higher than in general population, and increases with time [77]. Patients with early Crohn's disease who are younger than 25 years of age are at the higher risk for tumour development [78]. Dysplasia precedes development of the colorectal cancer [79] which in a majority of cases shows a clear tendency to develop at the site of the inflammation. In one third of all cases, it has been recorded as developing at the site of the macroscopically unaffected part of the intestine [80]. A spreading infiltration to the digestive tract wall [81] with multiple focus points of the cancer [82] has also been observed.

The first case of a large intestine tumour connected with Crohn's disease was described in 1948 [83]. Since then, publications have recorded a couple of hundred similar cases. Patients with intense and intensifying inflammatory changes of the intestine, forming a background for basic long-lasting disease, are at a significantly increased risk of cancer. This is also true for those who have not had surgery for a pathologically affected segment that had been deemed necessary to remove [80, 83, 84]. It is believed that, due to the above deciding factors, the risk for development of cancer in Crohn's disease is 10 times higher than in the general population [85].

There are three characteristics of cancer in the course of Crohn's disease. As compared to de novo, cancer in Crohn's disease emerges at a much lower age (48 vs. 70 years of age), is much more often located in the right part of the colon (45%) and more frequently presents as a multiple-focus point [81, 82]. Multifocal development of cancer in Crohn's disease has been recorded in 14-40% of cases, while in de novo, developed cancer has only been reported in 4% of the cases [86]. It has also been recorded that a higher likelihood for development of cancer is associated with large-intestine stenosis. Crohn's disease large intestine stenosis has been recorded in 5-17% of cases. The chance for development of cancer when stenosis is present is 6.8%, and when stenosis is absent it is at 0.7% [87]. Colorectal cancer may also emerge in a distant segment of the intestine or in association to chronic fistulae between the large intestine and bladder [88], vagina [89] or skin [88,90].

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