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World J Gastroenterol. Jul 21, 2014; 20(27): 8783-8789
Published online Jul 21, 2014. doi: 10.3748/wjg.v20.i27.8783
Primary sclerosing cholangitis as an independent risk factor for colorectal cancer in the context of inflammatory bowel disease: A review of the literature
Rosy Wang, Rupert M Leong
Rosy Wang, Rupert W Leong, Gastroenterology and Liver Services, Concord Hospital, Sydney, Concord NSW 2139, Australia
Author contributions: Wang R contributed to this work; Leong RW designed the research; Wang R performed the literature review and analysed the data; Wang R and Leong RW wrote the paper.
Supported by Career Development Fellowship of the National Health and Medical Research Council of Australia, to Leong RW
Correspondence to: Rupert W Leong, Associate Professor, Gastroenterology and Liver Services, Concord Hospital, Level 1 West, Hospital Rd, Sydney, Concord NSW 2139, Australia. rupertleong@outlook.com
Telephone: +61-2-9767 6111 Fax: +61-2-9767 6767
Received: October 13, 2013
Revised: January 21, 2014
Accepted: April 5, 2014
Published online: July 21, 2014
Abstract

To examine and evaluate recent evidence regarding the epidemiology, pathogenesis and management of colorectal cancer (CRC) development in inflammatory bowel disease (IBD)-primary sclerosing cholangitis (PSC) patients. Using the PubMed database, a literature search was conducted for relevant articles in English from the past 10 years. Relevant studies investigating PSC as a risk factor for CRC in IBD in the context of incidence and prevalence, pathogenesis, prevention and prognosis were included in this review. Recent evidence increasingly points to PSC as a significant risk factor in the development of CRC in patients with concomitant IBD. PSC may be an important risk factor for CRC in different populations worldwide. The mechanism for this increase in risk is still unclear. The efficacy of UDCA as a chemopreventive agent remains controversial. Liver transplantation does not halt the development of CRC, although there is not enough evidence to suggest that it is associated with increased incidence of CRC. While routine colonoscopic surveillance should be performed in patients with concurrent PSC and IBD, more high-level evidence is required to support the benefits of the procedure. While many new developments have taken place in the last decade, the pathogenesis and optimal management of CRC development in IBD-PSC patients remain unclear.

Keywords: Primary sclerosing cholangitis, Ulcerative colitis, Crohn’s, Inflammatory bowel disease, Colorectal cancer, Liver transplantation, Ursodeoxycholic acid

Core tip: The widely accepted risk factors for malignant transformation in inflammatory bowel disease (IBD) are disease duration and extent of inflammation. Since first proposed in 1992, one increasingly recognised independent risk factor for colorectal cancer development in IBD patients is concomitant primary sclerosing cholangitis.