Patients with ulcerative colitis are increased risk for developing colorectal carcinoma. The presence of certain factors can help identify a person at increased risk for cancer.
Risk factors from Hardy et al:
(1) duration of disease
(2) extent of disease
(3) dysplasia
(4) primary sclerosing cholangitis
(5) family history of colon carcinoma in a first degree relative
(6) coexisting adenomatous polyps
Risk Factor
Low Risk
Intermediate Risk
High Risk
duration of disease
<= 10 years
> 10 years
extent of disease
proctitis only
extensive
dysplasia
none
low grade
high grade
primary sclerosing cholangitis
absent
present
family history of colon cancer
none
present
adenomatous polyps
none
one
multiple
after table on page 888
Risk factors listed by Krok and Lichtenstein are similar, with the following modification:
(1) duration of disease: increased risk occurs at > 8 years
(2) family history: additional risk if a first degree relative developed colon cancer before age 50
(3) possibly the age of onset (although this may be a measure of duration)
Interpretation:
• A patient with ulcerative colitis and multiple risk factors should undergo close monitoring. Patients at high risk may benefit from a prophylactic total colectomy.
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