COLITIC CANCER-SURVEILLANCE & SURGERY

DOI 90 References
  • FUJII Hisao
    Department of Endoscopy & Ultrasound, Nara Medical University

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  • Ｃｏｌｉｔｉｃ　ｃａｎｃｅｒ‐サーベイランスと外科治療

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Abstract

In western countries, it has been well known that inflammatory bowel disease is a high risk group for colorectal cancer. In Japan, it has become a major clinical problem as the number of patients with ulcerative colitis (UC) increased gradually and the long-standing cases in-creased. In order to detect early colitis cancer dysplasia, several surveillance programs for patients with long-standing extensive UC have been proposed. Because it is endoscopically difficult to find out the "flat" dysplasia against the inflammatory mucosa, a series of more than 30 random biopsies is recommended. However, because magnifying chromoendoscopy has enhanced the ability to visually identify dysplasia/cancer, targeted biopsy, an alternate method of sampling doubtful lesions selectively has been discussed. Although colectomy is generally recommended in case that high-grade dysplasia or DALM (dysplasia associated lesion or mass) is detected as a result of the surveillance, controversy exists as to the proper management of low-grade dysplasia, and gastroenterologists may not fully understand the ramifications involved. Restorative proctocolectomies, subtotal colectomy and ileal-pouch anal anastomoses (IPAA) are widely each performed on surgery-candidates, and operative results are satisfac-tory. However, a few cases of dysplasia/cancer after IPAA were reported and, therefore, annual follow-up should be continued after colectomy. Prognosis of the early colitic cancer seems to be as good as ordinary colorectal cancer, hence enlightenment of the physicians as well as the patients may be a key to bringing the surveillance to successful completion.

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