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World J Gastrointest Oncol. Mar 15, 2022; 14(3): 547-567
Published online Mar 15, 2022. doi: 10.4251/wjgo.v14.i3.547
Inflammatory bowel disease-related colorectal cancer: Past, present and future perspectives
Snehali Majumder, Uday Nagesh Shivaji, Rangarajan Kasturi, Alben Sigamani, Subrata Ghosh, Marietta Iacucci
Snehali Majumder, Alben Sigamani, Department of Clinical Research, Narayana Health, Bangalore 560099, Karnataka, India
Uday Nagesh Shivaji, Subrata Ghosh, Marietta Iacucci, National Institute for Health Research Birmingham Biomedical Research Centre, University Hospitals Birmingham, Birmingham B15 2TH, United Kingdom
Uday Nagesh Shivaji, Subrata Ghosh, Marietta Iacucci, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TH, United Kingdom
Rangarajan Kasturi, Department of Gastroenterology, Narayana Health, Bangalore 560099, India
Author contributions: Majumder S and Shivaji UN contributed literature search, data collection, data analysis, writing and editing manuscript, revision and final approval; Kasturi R, Sigamani A, Ghosh S and Iacucci M contributed writing and editing manuscript, revision and final approval.
Conflict-of-interest statement: The authors have none to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Uday Nagesh Shivaji, DSc, MBBS, MRCP, Senior Research Fellow, Staff Physician, National Institute for Health Research Birmingham Biomedical Research Centre, University Hospitals Birmingham, Mindelsohn Way, Birmingham B15 2TH, United Kingdom. u.n.shivaji@bham.ac.uk
Received: March 15, 2021
Peer-review started: March 15, 2021
First decision: April 6, 2021
Revised: April 21, 2021
Accepted: February 25, 2022
Article in press: February 25, 2022
Published online: March 15, 2022
Processing time: 359 Days and 20.9 Hours
Abstract

Inflammatory bowel disease-related colorectal cancer (IBD-CRC) is one of the most serious complications of IBD contributing to significant mortality in this cohort of patients. IBD is often associated with diet and lifestyle-related gut microbial dysbiosis, the interaction of genetic and environmental factors, leading to chronic gut inflammation. According to the “common ground hypothesis”, microbial dysbiosis and intestinal barrier impairment are at the core of the chronic inflammatory process associated with IBD-CRC. Among the many underlying factors known to increase the risk of IBD-CRC, perhaps the most important factor is chronic persistent inflammation. The persistent inflammation in the colon results in increased proliferation of cells necessary for repair but this also increases the risk of dysplastic changes due to chromosomal and microsatellite instability. Multiple pathways have been identified, regulated by many positive and negative factors involved in the development of cancer, which in this case follows the ‘inflammation-dysplasia-carcinoma’ sequence. Strategies to lower this risk are extremely important to reduce morbidity and mortality due to IBD-CRC, among which colonoscopic surveillance is the most widely accepted and implemented modality, forming part of many national and international guidelines. However, the effectiveness of surveillance in IBD has been a topic of much debate in recent years for multiple reasons — cost-benefit to health systems, resource requirements, and also because of studies showing conflicting long-term data. Our review provides a comprehensive overview of past, present, and future perspectives of IBD-CRC. We explore and analyse evidence from studies over decades and current best practices followed globally. In the future directions section, we cover emerging novel endoscopic techniques and artificial intelligence that could play an important role in managing the risk of IBD-CRC.

Keywords: Inflammatory bowel disease; Colorectal cancer; Colitis-associated cancer; Surveillance in inflammatory bowel disease; Dye-spray colonoscopy; Adenomas; Dysplasia; Colectomy

Core Tip: The focus of the review is on the evolution of inflammatory bowel disease-related colorectal cancer (IBD-CRC) based on literature over the past decades to the present day. We provide a comprehensive overview of risk factors associated with IBD-CRC, molecular pathways identified and current strategies used to reduce incidence globally. We also touch upon the history of surveillance practice, its effectiveness, and the latest guidance on IBD surveillance by international societies. In a section on future directions, we discuss introduction of novel endoscopic technologies, artificial intelligence, and potential use of microbiota modulation, all of which could help reduce the risk of IBD-CRC.