Colon Cancer Surveillance in IBD

Colorectal cancer surveillance uses planned colonoscopies to find precancer changes (dysplasia) early in inflammatory bowel disease. It matters most for people with long‑standing colonic inflammation. Most societies advise starting around 8 to 10 years after diagnosis, sooner for some. Intervals then depend on risk factors like primary sclerosing cholangitis, prior dysplasia, family history, and how active inflammation has been. (gastro.org)

Key takeaways

• Surveillance is needed for ulcerative colitis beyond the rectum and for Crohn’s colitis when at least one third of the colon is involved. Proctitis alone does not need IBD‑specific surveillance. (journals.lww.com)

• First exam: about 8 to 10 years after diagnosis or first symptoms. With primary sclerosing cholangitis, start at diagnosis and repeat yearly. (gastro.org)

• After a negative baseline exam, repeat every 1 to 5 years based on risk. Many programs use 1, 3, or 5‑year intervals. (gastro.org)

• High‑quality technique improves detection. High‑definition scopes and chromoendoscopy are preferred, with targeted biopsies of any abnormal areas. (gastro.org)

Who needs colonoscopic surveillance

• Ulcerative colitis that extends beyond the rectum. People with proctitis only follow average‑risk population screening. (journals.lww.com)

• Crohn’s disease involving the colon, when about one third or more of the colon is affected. Limited colonic involvement below this threshold usually follows average‑risk screening. (journals.lww.com)

• People with an ileal pouch after colectomy are considered separately. Those with prior dysplasia or cancer, primary sclerosing cholangitis, or persistent significant pouch inflammation need regular pouch checks. (gastro.org)

Why not everyone Cancer risk rises with the amount and years of colonic inflammation. Disease limited to the rectum or small bowel has not shown the same risk and does not need an IBD‑specific program. (academic.oup.com)

When to start

• Standard start: 8 to 10 years after diagnosis or first symptoms of colonic IBD. This first exam confirms how far disease extends and sets a baseline. (gastro.org)

• Primary sclerosing cholangitis (PSC): begin at PSC diagnosis, then yearly thereafter. Risk is higher regardless of disease extent. (journals.lww.com)

How often: risk‑based intervals

U.S. guidance suggests repeating surveillance every 1 to 5 years after a negative baseline, tailored to combined risk. European programs commonly group people into 1, 3, or 5‑year intervals. The table below blends these approaches to give a practical plan that most guidelines support. (gastro.org)

These intervals may be shortened after poor bowel preparation, incomplete exams, or if quality indicators are not met. They may be lengthened after two high‑quality negative exams with sustained healing. Decisions should account for age, other illnesses, and patient preference. (gastro.org)

Special situations

• After endoscopic removal of visible dysplasia: close surveillance is needed. Typical follow up is 12 to 24 months for small, completely resected low‑grade lesions, and 3 to 6 months for high‑grade dysplasia or large lesions. Surgery is advised if complete removal is not possible or dysplasia recurs. (pmc.ncbi.nlm.nih.gov)

• Pouch surveillance after ulcerative colitis surgery: at least yearly if there was prior dysplasia or cancer, PSC, or persistent moderate to severe pouchitis or pre‑pouch ileitis. Lower‑risk pouches can be individualized, often every 5 years. (gastro.org)

Preferred technique during surveillance

• Use a high‑definition colonoscope with careful inspection and cleaning. Dye spray chromoendoscopy or validated virtual chromoendoscopy improves dysplasia detection, especially in prior dysplasia or PSC. Take targeted biopsies of any abnormal areas. If dye is not used, many programs still add random biopsies. (gastro.org)

Quick checklist: does a person need IBD‑specific surveillance

• Ulcerative colitis beyond the rectum or Crohn’s colitis ≥ one third of colon If yes, start a program. If proctitis only or isolated small‑bowel disease, follow average‑risk screening. (journals.lww.com)

• Time since diagnosis or first symptoms ≥ 8 years If yes, plan baseline now (unless PSC, then start at PSC diagnosis). (gastro.org)

• Any high‑risk features (PSC, prior dysplasia, stricture, strong family history, ongoing moderate to severe inflammation) If yes, use annual intervals. (e-guide.ecco-ibd.eu)

FAQs

Does isolated proctitis need colon cancer surveillance

No. Proctitis alone follows general population screening, not an IBD‑specific program. Surveillance is aimed at colonic inflammation beyond the rectum. (academic.oup.com)

What if Crohn’s affects only short colon segments

If less than about one third of the colon is involved, most guidelines do not require an IBD‑specific surveillance program. Follow average‑risk screening unless disease extends. (journals.lww.com)

How do U.S. and European intervals differ

U.S. guidance suggests repeating every 1 to 5 years based on combined risks. European pathways commonly assign 1, 3, or 5‑year intervals by risk tier. Both approaches are risk‑based. (gastro.org)