Rectal Cancer and Crohns Disease

The association of Crohn's disease and cancer is uncommon, with an overall prevalence of 0.45% [45]. Carcinoma in Crohn's disease is associated with strictures, extensive disease and onset of the disease before the age of 30 years. Sandmeier reported 3 patients with cancer in Crohn's disease from a database of 661 patients between 1993 and 2001; only one patient had a rectal localisation (signet ring cell variant) 4 years after a subtotal colectomy with ileosig-moid anastomosis [45].

Connell et al. [46], in a review on 2500 patients with Crohn's disease from 1940 to 1992, described 15 patients who developed a carcinoma of the lower gastrointestinal tract. Thirteen patients had a cancer in the upper third of the rectum (one), in the lower third of the rectum (seven) and in the anus (five patients). Patients with a cancer arising in the rectum had long-standing severe anorectal disease with a stricture in four, a fistula in four, a proctitis in one and an abscess in two patients.

Nikias et al. [47] reviewed the medical records of 16 patients with simultaneous diagnosis of Crohn's disease and carcinoma with eight rectal lesions of which two developed cancer in a defunctionalised rectum. Six patients had severe anorectal disease.

Instead of a low rate of incidence of rectal cancer, in young patients with long-standing, severe ano-rectal Crohn's disease, the fate of the rectum should be considered.

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