Chronic Inflammation and Malignancy in Ulcerative Colitis

Ulcerative colitis (UC) is a chronic inflammatory bowel disease(IBD) associated with multiple colonic and extraintestinalcomplications, the most severe being the development of colorectalcancer (CRC). Compared to the general population, there is anincreased risk of CRC associated with UC. Although thepathogenesis of CRC in UC is unknown, most studies have linked itto long-standing inflammation as well as other risk factors suchas duration of disease, extent of inflammation, family history ofCRC, and coexisting conditions such as primary sclerosingcholangitis (PSC). UC is a life-long disease for which patientsenter a vigilant screening program which includes surveillancecolonoscopy to promote early detection of CRC yet somecontroversies exist regarding the cost effectiveness ofsurveillance colonoscopy and improving survival. Newer modalitiessuch as chromoendoscopy, narrow band imaging, high definitioncolonoscopy, and confocal microscopy have aided in developing amore targeted approach for early detection of dysplasia insurveillance colonoscopy. This review focuses on the role ofchronic colonic inflammation and dysplasia in development ofUC-associated CRC and current methods of screening, detection,chemoprevention, and treatment of UC-associated CRC