Text Size: S M L
Search

Themistocles Dassopoulos, MD

Dr Dassopoulos sees patients at
The Center for Advanced Medicine
4921 Parkview Place, St. Louis MO, 63110

and

Medical Building 2
Barnes-Jewish West County
10 Barnes West Drive, Creve Coeur, MO, 63141

Question:  My 35-year-old daughter has suffered from ulcerative colitis since age 15. Is she at risk for colon cancer and what can she do to decrease the risk?

Answer: The chronic inflammation of ulcerative colitis acts as a stimulus to the proliferating cells of the colon, thereby increasing the risk for colon cancer. However, not all patients with colitis are at increased risk.

The extent of inflammation is an important determinant. Patients with pancolitis (inflammation of the entire colon) are at greater risk than patients with less extensive involvement, and patients with proctitis (inflammation of the rectum only) or proctosigmoiditis (inflammation of the rectum and the sigmoid colon, but not the remainder of the colon) are at no increased risk. The duration of disease is also important.

The risk rises after  ten years of disease, and especially after 20 years.

Other important risk factors are a family history of colon cancer (magnifies risk by 2) and, especially, the coexistence of primary sclerosing cholangitis, an inflammatory condition of the bile ducts, which multiplies risk by a factor of 4. According to older studies, the risk of colon cancer in the overall colitis population is 2-3% after 10 years of disease, 7-8% after 20 years, and around 15% after 30 years. In comparison, the lifetime risk of colon cancer in the general population is around 6%.

A standard agent for the treatment of ulcerative colitis is mesalamine, used to treat acute attacks and prevents relapses. Several recent studies have shown that it decreases the risk of colon cancer as well. Colonoscopy is also important, as it detects pre-cancerous lesions (termed dysplasia) before they progress to cancer, as well as early cancer.

New methods, such as special dyes to stain the colon, and novel optics to better image the colon, appear to detect more dysplasia/cancer than standard colonoscopy. Regular visits to the doctor also have a protective effect, possibly because better clinic follow-up is associated with higher medication compliance and/or healthier lifestyles that themselves decrease risk.

Your daughter should be taking mesalamine at a dose of at least 2.4 grams daily, followed carefully by her gastroenterologist, and should undergo colonoscopy at regular intervals. With these measures, her risk of colon cancer will decline significantly. Indeed, studies from the 1990s have suggest that the risk of colon cancer in colitis has fallen significantly.
Washington University Physicians are the medical staff of  Barnes-Jewish Hospital and Children's Hospital - St. Louis Employment   About Us   Top Stories   For Your Protection      Site Map
Copyright 2009 Washington University School of Medicine
Copyright 2009 Washington University School of Medicine