Small Bowel Cancer in Crohn's Disease

Simple Summary Crohn's disease (CD) affects the digestive tract, but the ileum is the most frequently involved segment. Compared to the general population, patients with CD are at higher risk of developing small bowel cancer (SBC). However, as it is a very rare event, specific surveillance is not recommended. The pathogenesis of SBC remains unclear, but some risk factors have been identified over time, such as chronic uncontrolled inflammation, long duration of CD, and perianal disease. SBC can manifest with non-specific symptoms, such as abdominal pain, so it can be hard to diagnose. While intestinal ultrasound, magnetic resonance imaging, and video capsule may suggest the presence of SBC, the definitive diagnosis is based on histology. Although there are still very few data on this topic, physicians should be mindful of the risk of SBC in CD.Abstract Crohn's disease (CD) is a chronic inflammatory bowel disease (IBD) that frequently affects the small bowel. Individuals diagnosed with CD are at increased risk of developing bowel cancer compared to the general population. Small bowel cancer is a rare but significant CD complication. Adenocarcinoma represents the most prevalent of these neoplasms, followed by neuroendocrine tumors and sarcomas. The primary risk factors identified are being of the male sex, disease duration, previous surgical intervention, perianal disease, and chronic inflammation. The precise etiology remains unclear. Another crucial issue concerns the role of immunomodulators and advanced therapies. By inhibiting inflammation, these therapies can reduce the risk of cancer, which is often initiated by the inflammation-dysplasia-adenocarcinoma sequence. In accordance with the most recent guidelines, it is not necessary to conduct surveillance in patients with small bowel cancer among CD patients, as it is considered a rare disease. Nevertheless, it is of significant importance for gastroenterologists to be aware of this potential CD complication, as well as the patients who are most at risk of developing it. The purpose of this review is to provide a comprehensive overview of CD-SBC, focusing on epidemiology, etiopathogenesis, risk factors, diagnosis, and the role of advanced therapies in CD-SBC.