Surveillance for cancer and dysplasia in inflammatory bowel disease

Colorectal cancer (CRC) remains a significant cause of mortality in patients with inflammatory bowel disease (IBD). Although most of the studies on the risk of CRC in IBD have been performed in patients with ulcerative colitis (UC), there is convincing evidence that patients with Crohn's disease (CD) have a similar risk of developing neoplasia. Although the risk of cancer in MD remains rare, the fact that it occurs in the setting of known risk factors and at a younger age than non-IBD-related colon cancer therefore warrants prevention strategies. Current guidelines for prevention of cancer in IBD recommend routine surveillance colonoscopies with random biopsies and consideration of proctocolectomy if precancerous dysplasia is identified and confirmed. Although this approach remains of good clinical rationale, the evidence for its benefit is minimal or lacking. This article reviews the rationale and evidence for such a practice and compares current guidelines.