Colorectal cancer in patients with ulcerative colitis
thesisposted on 15.12.2014, 10:31 by Jayne Alison. Eaden
The magnitude of the colorectal cancer (CRC) risk in ulcerative colitis (UC) was determined in the first meta-analysis of all 116 studies reporting the risk. For any patient with UC the risk was 2% at ten years, 8% at twenty years and 18% after thirty years. The risk was greater in children, varied geographically and has fallen since 1955.;A case-control study of 204 patients across the United Kingdom demonstrated regular aminosalicylate therapy reduced cancer risk by 75% (p<0.00001). Mesalazine was particularly effective reducing risk by 81% (p=0.006). Visiting a hospital doctor more than twice a year and attending regular colonoscopies also reduced risk (84% and 78%). A family cancer history increased risk five fold.;A reliable, self administered questionnaire measuring patient knowledge was developed. No correlation was found between patient knowledge and the risk of developing CRC. A randomized controlled trial compared the efficacy of a video (scripted and produced by the author) vs. an information leaflet on patient knowledge. This established that both media improved knowledge (71% and 49%) but neither intervention was significantly more effective than the other.;The first nationwide audit of surveillance practices amongst gastroenterologists ascertained 94% of consultants practiced surveillance but it was extremely disorganized and considerable disagreement existed concerning the management of dysplasia.;A new immunohistochemical marker for dysplasia (CYP1B1) was investigated. Although CYP1B1 showed faint staining in dysplastic tissues, it was inconsistent and presently would not improve identification of dysplasia.;The CRC risk in UC is significant and may be modified through regular consumption of aminosalicylates. Resources may be better allocated at improving compliance with such medication and targeting surveillance on high risk patients. Standardization of surveillance through national guidelines is needed urgently.