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Early detection and prevention of carcinoma of the colon in patients with ulcerative colitis
Author(s) -
Dobbins William O.,
Stock Merril,
Ginsberg Allen L.
Publication year - 1977
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(197711)40:5+<2542::aid-cncr2820400922>3.0.co;2-h
Subject(s) - medicine , ulcerative colitis , carcinoma , gastroenterology , colitis , colonic carcinoma , disease
Ulcerative colitis, particularly when there is total colonic involvement, is a premalignant lesion of the colon. We review the available methods for the early detection and prevention of colonic carcinoma in patients with ulcerative colitis. These methods include detection of precancer (carcinoma in situ ) in rectal and colonic biopsies, with and without immunoperoxidase staining for carcinoembryonic antigen; detection of persistently elevated serum carci‐noembryonic antigen; roentgenologic detection; colonoscopic detection; cytologic detection; and simple recommendation of total colectomy in all patients with continuously active, extensive colitis after 10 years of disease. Currently, of these methods available, only detection of precancer (carcinoma in situ ) in rectal and colonic biopsies holds promise for the early detection of colonic carcinoma, and there are many pitfalls with this method. Precancer, when analyzed in total colectomies, is absent in 12% of patients with carcinoma complicating ulcerative colitis and is found in the rectum in only 66% of these patients. Thirteen percent of patients with severe ulcerative colitis requiring colectomy have precancer in the absence of cancer. Precancer, when analyzed in rectal biopsies of patients with ulcerative colitis, is found in 5.7% of the patients. Thirty‐two percent (17/53) of those patients with precancer in rectal biopsy were found to have colonic carcinoma, while two‐thirds of these patients did not have colonic cancer. The role of colonoscopy at regular intervals with the collection of multiple biopsies throughout the colon is currently being evaluated in hopes that this method will more accurately and consistently permit early detection of precancer and cancer in patients with ulcerative colitis of 10 or more years' duration.