IS COLONOSCOPIC CANCER SURVEILLANCE IN ULCERATIVE-COLITIS ESSENTIAL FOR EVERY PATIENT

Surveillance aims to diagnose precancer or cancer at a surgically cura ble stage. Cancer complicating ulcerative colitis affects only 1-2 per million of the general population annually. The risk is low within 10 years of disease onset, and in proctitis or left-sided colitis. It is approximately one in 120 per year for those with extensive disease af ter 10 years from onset. Results of surveillance programmes from regio nal hospitals among 423 patients led to surgery for precancer or cance r once every 123 colonoscopies; there were no cancer deaths during sur veillance and all 4 cancers were Dukes' stage A or B. At referral cent res, many patients have dysplasia at the first colonoscopy. Two-thirds of cancers in colitis develop in the recto-sigmoid; flexible sigmoido scopy has a role in surveillance which is untested. Colonoscopic surve illance is not appropriate for most patients with colitis; it is worth while but not essential for those with long-standing extensive disease .