Hôpital Saint-Antoine, Service de gastro-entérologie et nutrition, 184 rue du faubourg Saint-Antoine, 75571 Paris cedex 12, France ; Sorbonne Université, F-75012, Paris, France
The main risk of cancer associated with the chronic use of thiopurines and/or anti-Tumor Necrosing Factor (TNF) agents in Inflammatory Bowel Disease is the risk of lymphoma. The absolute excess risk is mild to moderate, except in in men over the age of sixty years, and, for thiopurines, in patients seronegative for Epstein-Barr-Virus. Sun protection and skin surveillance are recommended from the diagnosis in all patients with IBD, irrespective of IBD treatment. Patients without colitis are at average risk of colorectal cancer, but should undergo colonoscopy surveillance from the age of 50 years, since immunological fecal tests are not appropriate in the context of IBD. The remaining patients should undergo colonoscopy surveillance according to the international guidelines. In patients with Crohn's ileitis, the risk of small bowel adenocarcinoma becomes substantial after 10 to 15 years of IBD duration and should be considered in therapeutic decisions. Patients with longstanding perianal Crohn's disease, in particular those with perianal fistulae, are at high risk of anorectal cancer and should undergo routine proctologic examination. In patients with recent cancer, IBD-related or not, resumption of immunosuppressive therapy should be avoided during a 2 to 5-year period after cancer treatment, except in case of severe uncontrolled IBD. This rule applies particularly to cancers associated with a high risk of late metastatic recurrence (some melanomas and breast cancers). IBD drugs that are able to achieve early, substantial and sustained reduction in chronic intestinal inflammation should theoretically decrease the risk of inflammation-associated cancers. To date, this feature has been demonstrated for colorectal cancer only, with an intermediate evidence level in patients with ulcerative regularly exposed to 5-amino-salicylates, and with a low level of evidence in patients with longstanding extensive colitis exposed to thiopurines.
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