Features of development and progression of colorectal cancer on a background of ulcerative colitis

Aim of investigation. To study features of development and course of colorectal cancer (CRC) in patients with ulcerative colitis (UC), and to determine risk groups for CRC on a background of UC.

Material and methods. Retrospective analysis of 65 cases with diagnosed CRC (2,1%) of 3154 patients with UC (treated in The State Scientific Centre of Coloproctology, Moscow, Russia from 1981 to 2010).

Results. UC was diagnosed at the age of under 10 years in 5 patients (7,7%), from 10 to 19 years – in 16 (24,6%), 20–29 years – in 27 (41,5%), 30–39 years – in 4 (6,2%), 40–49 years – in 6 (9,2%), from 50 years and over – in 7 (10,8%). The left-side lesion was revealed in 8 patients (12,3%), proctitis – in 8 (12,3%), total involvement of the large intestine – in 49 (75,4%). Chronic relapsing course was observed in 49 cases (75,4%). Duration of UC past history at the moment of CRC diagnosis was: less then 5 years – in 6 patients (9,2%), 6–10 years – in 10 (15,4%), 11–15 years – in 18 (27,7%), 16–20 years – in 9 (13,8%), 21–25 years – in 6 (9,2%), 26–30 years – in 14 (21,5%), 31–35 years – in 2 (5,1%). The tumor was localized in rectum in 30 cases (46,2%), in the caecum in 8 cases (12,3%), in sigmoid colon – in 13 (20,0%), in ascending colon, left flexure and descending colon respectively in 4 (6,2%). In 1 patient (1,5%) tumor was localized in the right flexure and in 1 (1,5%) – in transverse colon. In 12 patients (18,5%) CRC was characterized by primary multifocal with up to 5 tumors in different regions of the large intestine in T4N0M0stage. In 7 (10,8%) cases of 65 the signs of dysplasia of intestinal epithelium were not revealed, in 24 (36,9%) dysplasia of moderate degree and in 34 (52,3%) – high degree was observed. In 32 patients (49,0%) the type of tumor was moderately-differentiated adenocarcinoma, 7 patients (10,8%) had mucous and poorly differentiated adenocarcinoma, 6 (9,2%) – tubular-villous adenoma, 9 (13,8%) – welldifferentiated adenocarcinoma and 4 (6,2%) – gobletcell cancer. According to ТNM classification tumor at Т4 stage was revealed in 48 (73,8%) patients, Т3 – in 15 (23,1%), Т2 – in 2 (3,1%); N0 – in 56 (86,2%), N + in 9 (13,8%). In 6 (6,2%) patients distant metastases were found. All patients survived for 1 year after operation (100%), 5-years survival rate was 76,9%.

Conclusions. The risk of CRC development, apparently, directly depends on duration of intestinal inflammatory process, growing exponentially after 10 years of disease history. Combined effect of disease duration and UC intestinal extent increases probability of CRC development several times. Presence of two peaks of CRC development – at patients with 11 to 15 years of UC past history and from 26 to 30 years has been revealed.

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