Cutting Edge: Chemoprevention of Colorectal Neoplasia in Inflammatory Bowel Disease

Giovanni      C. Actis; Sonia      Tarallo; Floriano      Rosina

Abstract

Colitis-associated cancer represents a long-standing problem, with two new factors adding to its importance: the diffusion of inflammatory bowel disease in developing countries, and the increased availability of effective drugs that control ulcerative colitis delaying or abrogating the need for a curative colectomy. The consolidated evidence that inflammation is the unique variable that factors in colitic cancer development has conferred impetus to the search and release of anti-inflammatory/immune suppressive molecules to pursue the goal of cancer chemoprevention. Cutting-edge research has provided breakthrough insights into the mechanism of the chemopreventive actions of mesalamines, thiopurines, and probiotics, and we expand on these topics. Despite these advancements, bedside evidence is still mixed and calls for further scrutiny. Nowadays, the clinician must continue to rely on classic preventive measures such as surveillance colonoscopy, and the early and aggressive use of drugs that permit to keep the degree of mucosal inflammation to a minimum.

Keywords: Chemoprevention, colitis-associated cancer, colon cancer, inflammatory bowel disease, mucosal inflammation, probiotic, TNF-alpha, Chemokines, IL-6, NF-κB