Munkholm, P. Review article: the incidence and prevalence of colorectal cancer in inflammatory bowel disease. Aliment. Pharmacol. Ther. 18 (Suppl 2), 1-5

Department of Medical Gastroenterology, Hvidovre University Hospital, Copenhagen, Denmark.
Alimentary Pharmacology & Therapeutics (Impact Factor: 5.73). 10/2003; 18 Suppl 2(s2):1-5. DOI: 10.1046/j.1365-2036.18.s2.2.x
Source: PubMed


Although colorectal cancer (CRC), complicating ulcerative colitis and Crohn's disease, only accounts for 1–2% of all cases of CRC in the general population, it is considered a serious complication of the disease and accounts for approximately 15% of all deaths in inflammatory bowel disease (IBD) patients.
The magnitude of the risk was found to differ, even in population-based studies. Recent figures suggest that the risk of colon cancer for people with IBD increases by 0.5–1.0% yearly, 8–10 years after diagnosis. The magnitude of CRC risk increases with early age at IBD diagnosis, longer duration of symptoms, and extent of the disease, with pancolitis having a more severe inflammation burden and risk of the dysplasia-carcinoma cascade.
Considering the chronic nature of the disease, it is remarkable that there is such a low incidence of CRC in some of the population-based studies, and possible explanations have to be investigated. One possible cancer-protective factor could be treatment with 5-aminosalicylic acid preparations (5-ASAs).
Adenocarcinoma of the small bowel is extremely rare, compared with adenocarcinoma of the large bowel. Although only few small bowel cancers have been reported in Crohn's disease, the number was significantly increased in relation to the expected number.

  • Source
    • "The incidence of chronic intestinal diseases such as ulcerative colitis and Chron's disease is continually increasing in different regions of the world (Latella and Papi, 2012) and the complications can account for almost 15% of all deaths (Munkholm, 2003). 5-Aminosalicylic acid (5ASA) is an anti-inflammatory drug used in the treatment of intestinal diseases, which has been considered as a potential chemopreventive agent (Velayos et al., 2005). "
    [Show abstract] [Hide abstract]
    ABSTRACT: This work introduces results on a new drug delivery system (DDS) based on the use of chitosan/layered double hydroxide (LDH) biohybrid beads coated with pectin for controlled release in the treatment of colon diseases. Thus, the 5-aminosalicylic acid (5ASA), the most used non-steroid-anti-inflammatory drug (NSAID) in the treatment of ulcerative colitis and Crohn's disease, was chosen as model drug aiming to a controlled and selective delivery in the colon. The pure 5ASA drug and the hybrid material prepared by intercalation in a layered double hydroxide of Mg2Al using the co-precipitation method, were incorporated in a chitosan matrix in order to profit from its mucoadhesiveness. These compounds processed as beads were further treated with the polysaccharide pectin to create a protective coating that ensures the stability of both chitosan and layered double hydroxide at the acid pH of the gastric fluid. The resulting composite beads presenting the pectin coating are stable to water swelling and procure a controlled release of the drug along their passage through the simulated gastrointestinal tract in in vitro experiments, due to their resistance to pH changes. Based on these results, the pectin@chitosan/LDH-5ASA bionanocomposite beads could be proposed as promising candidates for the colon-targeted delivery of 5ASA, with the aim of acting only in the focus of the disease and minimizing side effects.
    Full-text · Article · Dec 2013 · International Journal of Pharmaceutics
  • Source
    • "At the same time, patients with IBD, and particularly UC, remain at increased risk for colorectal cancer [35, 36]. Long-term ASA treatment has been shown to be effective for colon cancer prevention [37–40]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The role of non-steroidal anti-inflammatory drugs in inflammatory bowel disease is controversial, as they have been implicated in disease aggravation. Different from other cyclooxygenase inhibitors, acetylsalicylic acid (ASA) enhances the formation of anti-inflammatory and proresolution lipoxins derived from arachidonic acid as well as resolvins from omega-3 polyunsaturated fatty acids such as docosahexaenoic acid (DHA). In this study, we examined the effect of ASA on murine dextran sodium sulfate colitis. A mouse magnetic resonance imaging (MRI) protocol and post mortem assessment were used to assess disease severity, and lipid metabolites were measured using liquid chromatography-coupled tandem mass spectrometry. Decreased colitis activity was demonstrated by phenotype and MRI assessment in mice treated with ASA, and confirmed in postmortem analysis. Analysis of lipid mediators showed sustained formation of lipoxin A4 and an increase of DHA-derived 17-hydroxydocosahexaenoic acid (17-HDHA) after treatment with ASA. Furthermore, in vitro experiments in RAW264.7 murine macrophages demonstrated significantly increased phagocytosis activity after incubation with 17-HDHA, supporting its proresolution effect. These results show a protective effect of ASA in a murine colitis model and could give a rationale for a careful reassessment of ASA therapy in patients with inflammatory bowel disease and particularly ulcerative colitis, possibly combined with DHA supplementation.
    Full-text · Article · Sep 2013
  • Source
    • "Inflammation has been widely known as strong risk and promoting factor of carcinogenesis (Balkwill and Mantovani, 2001) in various types of human cancers (Ohshima et al., 2003). Among them, ulcerative colitis is in high risk condition in colonic carcinogensis (Munkholm, 2003). In the animal counterpart, dextran sulfate sodium (DSS) (Okayasu et al., 1990) showed powerful tumor promoting effect in murine colonic carcinogenesis models initiated with azoxymethane (AOM) (Tanaka et al., 2003), 1,2-dimethylhydrazine (DMH) (Kohno et al., 2005), and 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP) (Tanaka et al., 2005). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Inflammation is potential risk factor of various human malignancies. Inflammatory bowel syndromes such as ulcerative colitis are well known as risk factors for colon cancer. Here, we examined enhancing effects of dextran sulfate sodium (DSS)-associated inflammation on X-irradiation induced colonic tumorigenesis in Min and wild-type (WT) mice. Animals were X-irradiated at 1.5 Gy at 5 weeks of age (at 0 experimental week) and 2% DSS in drinking water was administered at 5 or 11 experimental weeks. Mice were sacrificed at 16 weeks and incidence and multiplicity of colonic tumors were assessed. Incidence of colonic tumors in Min mouse was increased from 33.3% to 100% (p<0.05) with X-irradiation alone, whereas no tumors were developed in WT mice. In DSS-treated Min mice, X-irradiation increased the number of colonic tumors. Total number of colonic tumors was increased 1.57 times to 30.7±3.83 tumors/mouse with X-irradiation+DSS at 5 weeks comapared to 19.6±2.9 in corresponding DSS alone group (p<0.05). When the duration of inflammation was compared, longer period of DSS effect promoted more colonic tumorigenesis. Collectively, we conclude that X-irradiation and DSS-induced inflammation act synergistically for colonic tumorigenesis.
    Full-text · Article · Jul 2013 · Asian Pacific journal of cancer prevention: APJCP
Show more