Colorectal cancer: Risk and prevention in inflammatory bowel diseases

The increased risk of colorectal cancer represents a significant problem in the clinical management of patients with long-standing ulcerative colitis or Crohn's disease with a predominant manifestation in the colon. Risk factors for the development of colorectal cancer in patients with these chronic inflammatory bowel diseases are a disease duration of at least 8-10 years, extensive disease (pancolitis) and the presence of the concomitant hepatobiliary complication, primary sclerosing cholangitis. Numerous epidemiologic studies provide strong evidence that sustained use of aspirin and other traditional nonsteroidal anti-inflammatory drugs (NSAIDs), which inhibit the cyclo-oxygenase-1 and -2 isoenzymes, may reduce the risk of colon cancer. Data from several retrospective analyses of patients with ulcerative colitis, which will be depicted in the following review, also suggest a potential chemopreventive role of sulfasalazine or 5-aminosalicylic acid.