Ulcerative Colitis and Colorectal Cancer: What to Know About the Connection

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Having a chronic illness like ulcerative colitis affects your health in so many ways, from the daily issues, like terrible pain, to the big picture, like an increased risk of colorectal cancer. The connection between ulcerative colitis and colorectal cancer can be scary and confusing, but it’s an important one to understand. Here’s what you need to know about it.

What is ulcerative colitis?

You probably already know this part, but a quick refresher doesn’t hurt. As a form of inflammatory bowel disease (IBD), ulcerative colitis creates inflammation in the gastrointestinal (GI) tract. This can lead to irritation and swelling as well as ulcers (sores) along the inner lining of the colon, or the large intestine, the National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK) explains.

Symptoms of ulcerative colitis can include diarrhea that has blood or pus, stomach pain, rectal pain or bleeding, the urgent feeling that you need to poop, an inability to poop, weight loss, fatigue, and fever, according to the Mayo Clinic. How severe your symptoms are depends on the level and location of inflammation in your GI tract, but as you may have experienced, they typically become worse over time, per the NIDDK.

The aim of ulcerative colitis treatment is long-term remission (periods of being symptom-free). According to the NIDDK, most people do achieve weeks or years of remission with a combination of medications, dietary modifications, and/or surgery.

How does ulcerative colitis affect colorectal cancer risk?

We’re about to get into the more nerve-wracking information here, so before we do, let’s be really clear: Having ulcerative colitis is in no way a guarantee that you’ll get colorectal cancer. But the condition does increase your risk of developing cancer in your colon and rectum (the last section of your colon). To make things less confusing, even though ulcerative colitis increases your risk of both colon cancer and colorectal cancer, we’ll refer to colorectal cancer throughout since it’s more all-encompassing.

Now, let’s talk about that increased risk. Overall, people who have chronic IBD (either ulcerative colitis or Crohn’s disease) have nearly double the odds of developing colorectal cancer than the general population, according to the American Cancer Society (ACS) Colorectal Cancer Facts & Figures 2017-2019 Report. “It’s important to recognize that the risk varies tremendously based on the type, severity, and location of the colitis,” Paul Oberstein, M.D., director of the Gastrointestinal Medical Oncology Program at NYU Langone’s Perlmutter Cancer Center, tells SELF. (Colitis means inflammation of the colon.)

People with colitis affecting the entire colon are at greater risk of these cancers, Dr. Oberstein says. On the other hand, people with colitis on only certain portions, like the left side, are generally considered to be at moderate risk, and those who have colitis only in the rectum are at lower risk, possibly similar to that of people without ulcerative colitis, according to some studies.

Whether or not the inflammation is prolonged also impacts risk. “The more severe or persistent the inflammation is, … the higher the risk of colorectal cancer is going to be,” Yinghong Wang, M.D., Ph.D., M.S., a gastroenterologist at MD Anderson Cancer Center, tells SELF.

A widely-cited 2001 meta-analysis of 116 studies published in Gut found that the lifetime incidence of colorectal cancer in people with ulcerative colitis was 3.7 percent. But this number changed dramatically when researchers looked at studies that also reported the duration of disease before colorectal cancer diagnosis. A disease duration of 10 years corresponded with a 2 percent chance of getting this cancer; 20 years, an 8 percent chance; and 30 years, an 18 percent chance.

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