Published online Feb 14, 2019. doi: 10.3748/wjg.v25.i6.659
Peer-review started: November 1, 2018
First decision: November 29, 2018
Revised: January 10, 2019
Accepted: January 14, 2019
Article in press: January 15, 2019
Published online: February 14, 2019
Primary sclerosing cholangitis (PSC) is a rare cholestatic liver disease characterized by progressive fibroinflammatory destruction of the intra- and/or extrahepatic biliary ducts. While its features and disease course can be variable, most patients with PSC have concurrent inflammatory bowel disease and will eventually develop liver cirrhosis and end-stage liver disease, with liver transplantation representing the only potentially curative option. Importantly, PSC is associated with a significantly increased risk of malignancy compared to the general population, mainly cholangiocarcinoma, gallbladder carcinoma, hepatocellular carcinoma, and colorectal cancer, with nearly 50% of deaths in patients with PSC being due to cancer. Therefore, robust surveillance strategies are needed, though uncertainty remains regarding how to best do so. In this review, we discuss the epidemiology, prevention, and surveillance of cancers in patients with PSC. Where evidence is limited, we present pragmatic approaches based on currently available data and expert opinion.
Core tip: Primary sclerosing cholangitis is a rare cholestatic liver disease characterized by progressive fibroinflammatory destruction of the bile ducts. It is associated with a significantly increased risk of malignancy over the general population, with nearly 50% of deaths in patients with primary sclerosing cholangitis caused by cancer, thus necessitating robust surveillance strategies. In this article, we provide a synopsis of the epidemiology, prevention, and surveillance of cancers in patients with primary sclerosing cholangitis.