CROHNS-DISEASE AND COLORECTAL-CARCINOMA - RECTAL-CANCER COMPLICATING LONGSTANDING ACTIVE PERIANAL DISEASE

Objectives: Reports of Crohn's disease (CD)-associated colorectal carc inoma are being cited in the medical literature with increasing freque ncy. Our aim was to identify subgroups of patients with risk factors t hat may account for this. Methods: We reviewed the medical records of 16 patients with the simultaneous diagnosis of CD and colorectal carci noma and, in addition, reviewed previously reported cases of CD-associ ated colorectal carcinoma. Results: Eight male and eight female patien ts presented with 18 carcinomas: four right colon, four transverse, tw o descending colon, and eight rectal lesions. Median age at presentati on was 48 yr. The mean duration of CD before presentation of carcinoma was 19.7 Sr. Two lesions were discovered in strictured bowel segments . Two patients had multiple cancers. One had simultaneous cecal and le ft colon adenocarcinomas. The other underwent resection of a right col on lesion and 5 yr later presented with transverse colon carcinoma. Ei ght patients had rectal cancer; all were diagnosed preoperatively. Six of these patients had a history of severe perianal CD. Six had underg one multiple incision and drainage procedures for perirectal abscesses and fistulas. Two developed malignancies in defunctionalized rectal s tumps. One of these patients presented with simultaneous squamous rect al carcinoma and papillary bile duct cholangiocarcinoma. Conclusions: Gastrointestinal malignancy in association with CD has been reported. Symptoms of chronic inflammatory disease may obscure clinical manifest ations of occult malignancy and thereby delay diagnosis. Crohn's patie nts with longstanding anorectal or perianal disease and stricture may well warrant surveillance endoscopy and biopsy of involved areas with the hope of earlier detection and treatment of these rectal cancers.