2018 Volume 60 Issue 1 Pages 57-63
Colitis-associated cancer/dysplasia is an important complication of ulcerative colitis (UC). However, it is difficult to diagnose the range and depth of the lesion of colitis-associated cancer/dysplasia. Even detection of such lesions is often difficult. Neoplastic atypical epithelium (dysplasia) is a precancerous lesion and a target of surveillance colonoscopy. Surveillance colonoscopies are performed starting 7 to 10 years after the onset of UC, preferably in the remission period. There are various macroscopic forms of UC-related tumors. However, dysplasias are often protruded. The presence of different mucosal patterns and color tone changes may suggest the presence of dysplasia. Redness with a demarcation line is also an important sign. In addition to white light observation, image-enhanced endoscopic methods such as chromoendoscopy and magnifying endoscopy are helpful. Histological examination is most important. In the past, step biopsy was recommended, but recently target biopsy was shown to be sufficient. Regarding examination of biopsy specimens, immunostaining for Ki-67 and p53 is also important. Determination of whether a tumor is derived from inflammation or not is important for treatment planning. Patients with colitis-associated cancer require total colectomy. The presence of surrounding dysplasia and overexpression of p53 protein suggests colitis-associated tumor.
