Risk of Cancer in Patients with Inflammatory Bowel Diseases and Keys for Patient Management

Simple Summary Inflammatory Bowel Diseases (IBDs) are increasingly prevalent pathologies due to the rise in incidence in some geographic areas and the improvement in prognosis with the development of new therapeutic targets. The increasing age of the IBD population is associated with greater comorbidity, including intestinal and extra-intestinal cancer. The current or previous presence of cancer makes the treatment of both IBD and cancer challenging. In this review, we summarize the evidence on IBD cancer risk related to chronic inflammation and immunosuppressive therapy, as well as a general approach to the management of patients with IBD and cancer. Chronic inflammation in patients with Inflammatory Bowel Disease (IBD) leads to an increased risk of colorectal cancer, small bowel cancer, intestinal lymphoma and cholangiocarcinoma. However, treatments for IBD have also been associated with an increased risk of neoplasms. Patients receiving Thiopurines (TPs) have an increased risk of hematologic malignancies, non-melanoma skin cancer, urinary tract neoplasms and cervical cancer. Anti-TNFs have been associated with a higher risk of neoplasms, mainly lymphomas and melanomas; however, the data are controversial, and some recent studies do not confirm the association. Nevertheless, other biologic agents, such as ustekinumab and vedolizumab, have not shown an increased risk of any neoplasm to date. The risk of malignancies with tofacitinib exists, but its magnitude and relationship with previous treatment with TPs is not defined, so more studies from daily clinical practice are needed. Although biologic therapy seems to be safe for patients with current cancer or a prior history of cancer, as has been demonstrated in other chronic inflammatory conditions, prospective studies in this specific population are needed. Until that time, it is crucial to manage such conditions via the combined clinical expertise of the gastroenterologist and oncologist.