COLORECTAL-CANCER IN ULCERATIVE-COLITIS - SURVIVAL IN PATIENTS WITH AND WITHOUT COLORECTAL-CANCER SYMPTOMS

Patients with ulcerative colitis are at increased risk for colorectal adenocarcinoma compared with the general population. Although surveill ance for colorectal malignancy and dysplasia (a premalignant lesion) h as been recommended, a benefit in reducing mortality from colorectal c ancer via surveillance or prophylactic colectomy is still being debate d. We reviewed the outcome of 40 consecutive patients with ulcerative colitis with colorectal adenocarcinoma diagnosed between 1956 and 1991 at The Johns Hopkins Hospital. The diagnosis of ulcerative colitis an d the tumor, node, metastasis (TNM) stage of colorectal cancer were ob tained from clinicopathologic records. Follow-up information was compl ete for all patients. Patients were divided into two groups: 18 asympt omatic patients who had colorectal cancer detected by colonoscopy, bio psies for dysplasia, or barium enema, or had undergone ''prophylactic' ' colectomy as part of a colorectal cancer-prevention strategy (asympt omatic group), whereas 22 patients did not undergo cancer-prevention t esting or prophylactic surgery and had symptoms of colorectal cancer ( symptomatic group). Colorectal cancer was diagnosed at a statistically significantly earlier cancer stage in the asymptomatic group [12 (67% ) of 18 at stage I or II] compared with those in the symptomatic group [two (9%) of 22 at stage I or II] (Wilcoxon test, p < 0.01). Colorect al cancer 5-year survival in the asymptomatic group was 89% [confidenc e limit (CL), 61-97%] and in the symptomatic group, 19% (CL, 6-39%). P atients with ulcerative colitis and asymptomatic colorectal cancer det ected as part of a prevention strategy had malignancies that were less invasive and showed greatly increased survival compared with patients with symptomatic colorectal cancer.