Having ulcerative colitis doesn’t mean you will get colorectal cancer, but it does increase your risk.
Ulcerative colitis is a chronic inflammatory bowel disease that affects the lining of the rectum and colon. It can be limited to the rectum or extend throughout the colon. Ulcerative colitis that affects the entire colon is called pancolitis.
The most common symptoms of ulcerative colitis are diarrhea and blood in your stool. Some patients may have abdominal pain. In severe cases, it can cause fever. Experts aren’t sure what causes the disease.
If you have ulcerative colitis, your immune system recognizes the lining of your colon as a foreign body and attacks it. Over time, this damages the colon. As your body tries to repair the damage, the inflammation and constant cell replacement can result in a mutation that leads to cancer.
The more extensive your colitis and the longer you have it, the greater your risk of colorectal cancer. Males are at higher risk. And if you have both primary sclerosing cholangitis, which is inflammation of the bile duct, that puts you at even greater risk for colorectal cancer.
What should I do to reduce my cancer risk if I have ulcerative colitis?
If you are diagnosed with primary sclerosing cholangitis, you should get a colonoscopy right away. Otherwise, you should begin getting colonoscopies every one to two years beginning at years after you were diagnosed with ulcerative colitis. This is to check for dysplasia or polyps that could lead to colorectal cancer. Your doctor can prevent cancer from developing by removing these precancerous cells or growths before they become cancer.
It’s also very important to keep inflammation under control with medication. Medications range from anti-inflammatory drugs to drugs that suppress your immune system. What your doctor prescribes will depend on the severity of your disease.
With the new medications that are coming out, we’re able to put ulcerative colitis in remission for some patients. If a patient has two colonoscopies in a row with no visual or microscopic evidence of damage, inflammation, polyps or abnormal cells, they are considered in remission.
For patients who do not respond to medication, surgery is an option. We can remove part or all of the colon. After the colon resection, waste is managed through an internal or external pouch.
Surgery is a cure. Because your colon is gone, the disease is gone, too.
What should cancer patients with ulcerative colitis know?
Cancer treatments like chemotherapy and immunotherapy can cause digestive problems, so it’s important to tell your doctor if you have an irritable bowel disease like Crohn’s or ulcerative colitis.
Before we start cancer treatment, we need to make sure that the ulcerative colitis is under control. That way, we can ensure that the side effects of cancer treatment will cause as little damage as possible.
Unfortunately, clinical trials for cancer treatment often exclude patients with irritable bowel disease because these studies often focus on patients who are otherwise healthy.
But MD Anderson is participating in a clinical trial sponsored by National Cancer Institute for patients with irritable bowel disease. Any patient with pre-existing irritable bowel disease and a new diagnosis of cancer can enroll to get immunotherapy for their cancer treatment. This is a good opportunity for irritable bowel disease patients to get a much better, closely monitored cancer therapy.
What should cancer patients know about immunotherapy-induced ulcerative colitis?
About 45% of patients will develop colitis from immunotherapy.
We treat immunotherapy-related colitis in the same ways as ulcerative colitis. Our success rate with medical treatment is close to 85%. We also offer fecal transplant through a clinical trial. Fecal transplant is an experimental treatment that seeks to reset the digestive system’s microbiome to treat colitis.
And, those patients who develop immunotherapy-induced colitis tend to have very low recurrence of their cancer. While the immunotherapy causes the colitis, it prevents the cancer from coming back. So it’s ultimately beneficial.