Colorectal cancer in inflammatory bowel disease: a shift in risk?

Patients with inflammatory bowel disease are at an increased risk for the development of colorectal cancer. However, the magnitude of this risk may not be as high as earlier studies have suggested. This shift in risk may be a result of changes in quality of analyses, aging cohorts, or may indeed represent true declines in the risk of cancer as a result of improvements in medical therapy and surveillance programs. The best surveillance practices for colorectal cancer screening in patients with inflammatory bowel disease remains unclear. The finding of dysplasia on colonoscopy in these patients warrants multi-disciplinary consultation between endoscopist, pathologist, and patient. At present, major organizations offer guidelines for surveillance interval, as well as when surgical consultation is advised. Moreover, newer endoscopic technologies have been developed and their incorporation into dysplasia surveillance programs continues to evolve.