Unveiling Cancer in IBD: Screening Colonoscopy or Chromoendoscopy
Department of Gastroenterology, Russell Hall Hospital, Pensett Road, Dudley, UK. .Current drug targets (Impact Factor: 3.02). 05/2012; 13(10):1268-72. DOI: 10.2174/138945012802429660
The risk of developing colorectal cancer (CRC) is increased in patients with inflammatory bowel disease (IBD), particularly if the disease is extensive and its duration long-standing. Endoscopic guidelines have been developed with the goal of detecting early neoplastic changes prior to development of advanced malignancy. The current surveillance strategy of surveillance colonoscopy, with multiple random biopsies, most likely reduces morbidity and mortality associated with IBD-related CRC. Unfortunately, standard surveillance colonoscopy also has limitations, including high cost and sampling error at time of biopsy. The main issue is that colitis associated neoplasms often occur in flat mucosa of normal appearance, and are detected on taking random biopsies rather than by direct identification of these lesions via endoscopic imaging. Advances in endoscopic imaging techniques, such as vital or optical chromoendoscopy, that can enhance mucosal characteristics, may potentially aid in increasing dysplasia detection rate, and may reduce the workload of standard random biopsies. The aim of this review was to describe and summarize outcomes of more advanced endoscopic imaging techniques, including chromoendoscopy and magnification endoscopy.
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ABSTRACT: Patients with long-standing inflammatory bowel disease (IBD) are at a higher risk of developing colorectal cancer (CRC). This risk increases with the longer duration of colitis, greater extent of inflammation, a family history of CRC, severity of bowel inflammation, and a coexistent primary sclerosing cholangitis. The cornerstone for comprehending the development of CRC in IBD and hence early detection is based on the understanding of the molecular pathways of IBD itself. At a molecular level, the pathogenesis of CRC is related to understanding the inflammatory changes and involves multiple inter-related pathways including (i) genetic alterations (e.g. chromosomal and microsatellite instability and hypermethylation), (ii) mucosal inflammatory mediators (e.g. COX-2, interleukin-6, interleukin-23, tumor necrosis factor-α, nuclear factor-κB, and chemokines), (iii) changes in the expression of receptors on the epithelial cells, and (iv) oxidant stress, mucosal breakdown, and intestinal microbiota. The aim of this review is to provide an evidence-based approach for the role of chronic inflammatory mechanisms and the molecular basis of these mechanisms in the development of CRC. Therefore, understanding the molecular basis of CRC is an important step for the identification of new biomarkers that can help in the early detection of CRC in these patients.
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