Colorectal cancer and cholangiocarcinoma in patients with primary sclerosing cholangitis and inflammatory bowel disease.

OBJECTIVE: Inflammatory bowel disease (IBD) patients with concomitant primary sclerosing cholangitis (PSC) carry an increased risk of colorectal cancer (CRC) and cholangiocarcinoma (CCA). We evaluated the relative risk of these malignancies in IBD patients with PSC, who had been under regular surveillance.

MATERIAL AND METHODS: The survey involved a cohort of 51 patients with IBD and concomitant PSC. All patients had been under regular surveillance for a median of 19 years. The standardized incidence ratios (SIRs) of CRC and CCA were estimated between 1986 and 2007.

RESULTS: During the follow up, three patients (5.9%) developed CRC and five patients (9.8%) developed CCA. SIRs were 20.71 (95% confidence interval [CI]: 5.62-79.70) and 916.63 (95% CI: 297.88-2140.99), respectively. The median age at diagnosis of CRC was 39.5 years. All patients with PSC were <45 years of age at the time of detecting CRC and had other risk factors for CRC. The median age at the time of the CCA diagnosis was 54.0 years.

CONCLUSION: Despite regular surveillance, the relative risks of CCA and CRC remained increased in patients with IBD and PSC. A rigorous endoscopic surveillance is maintained for all patients with PSC, but better indicators of the development of CCA are urgently needed.