ANNOUNCER: People with inflammatory bowel disease live with many concerns, including the knowledge that they are at higher-than-average risk of developing colorectal cancer.
DAVID T. RUBIN, MD: Colorectal cancer is cancer of the large intestine, which is the colon, and the rectum, which is the last part of that large intestine. It's an abnormal growth within the lining of the bowel.
ANNOUNCER: It's estimated that more than 150,000 Americans are diagnosed colorectal cancer yearly. About 1 percent of those diagnosed are people with IBD.
DAVID T. RUBIN, MD: Colorectal cancer, in its earliest stages, is considered a curable disease. But, unfortunately, it's often a symptomatic. And when it advances, it is not as treatable. So our goal, in colorectal cancer identification, is to find it in its earliest stages and cure it.
ANNOUNCER: The starting point for diagnosis is the use of an instrument that permits a doctor to view the interior surface of the colon.
STEVEN H. ITZKOWITZ, MD: Colon cancer is diagnosed best by colonoscopy, which allows you to look into the colon and see an abnormality and either sample it or remove it completely and look under the microscope. It's not usually enough to just look with your naked eye during colonoscopy and say, "This is cancer." You really should be confirming it with a biopsy.
ANNOUNCER: Among the general population, bumps, or polyps, are sometimes a sign of pre-cancerous change, or cancer itself.
STEVEN H. ITZKOWITZ, MD: With patients who have inflammatory bowel disease, we also may find these polyps or raised growths, but the problem is, there can also be precancerous or sometimes even cancerous changes that are flat and almost invisible. So we do multiple biopsies sampling the tissue throughout the colon to try to detect these areas that are otherwise invisible.
ANNOUNCER: The cell changes responsible for those flat growths are called dysplasia. When the changes are advanced, it's called high-grade dysplasia. But even the discovery of low-grade dysplasia prompts many doctors to recommend surgery to remove the colon.
THOMAS A. ULLMAN, MD: For patients who are diagnosed based on the surveillance examination as having dysplasia and that dysplasia is confirmed by an additional pathologist, it is always my recommendation that patients undergo a colectomy and, in fact, have their colon removed.
ANNOUNCER: Doctors say dysplasia or cancer generally takes time to develop, so colonoscopies do not need to begin immediately after diagnosis of IBD.
DAVID T. RUBIN, MD: Based on our understanding of the risk factors for dysplasia and cancer in inflammatory bowel disease, our guidelines suggest surveillance should begin after eight years of disease. So, in other words, eight years after someone is diagnosed with inflammation of their colon, they should start a protocol of periodic colonoscopies to survey the colon for precancerous changes.
ANNOUNCER: When a colectomy is performed after the discovery of dysplasia, that's usually all the treatment necessary. When cancer is present and has spread, additional treatment will be likely.
DAVID T. RUBIN, MD: For cancers that are advanced stages meaning the bowel -- the cancer has grown through the wall of the bowel into adjacent organs or has spread distantly, chemotherapy is part of the standard treatment for the colon cancer.
ANNOUNCER: For certain types of rectal cancers, a combination of chemotherapy and radiation therapy is used before surgery, to shrink the size of the tumor.
Despite the elevated risk of cancer for people with IBD, doctor's say there's no reason to be consumed by worry.
THOMAS A. ULLMAN, MD: We actually do a very good job of preventing cancer in ulcerative colitis and in Crohn's colitis. So the first thing that I really would tell patients is really, "Don't worry," and "Don't worry early on in the course of disease." Figure out how your disease is going to be over time. Build a strong alliance with your gastroenterologist, and then when the time comes, after eight years, do yourself the favor and have your annual colonoscopy.
There are very, very few breakthroughs of cancer amongst patients who have their annual colonoscopies.