Colorectal neoplasia in ulcerative colitis - recent advances

It is recognized that ulcerative colitis (UC) predisposes to the developmen t of colorectal adenocarcinoma (CRC), and the molecular pathway for this pr ocess differs from that for sporadic CRCs. However, several important detai ls regarding the risk factors for and the molecular changes underlying UC-r elated colorectal carcinogenesis have only come to light lately. First, rec ent data suggest environmental factors related to long-standing inflammatio n contribute more to this increased cancer risk than an inherited susceptib ility. Second, molecular changes that may represent the first steps in the development of neoplasia are being increasingly identified in non-dysplasti c, colitic mucosa. Third, there is now good evidence suggesting that UC-rel ated CRC may develop along more than one molecular pathway. These emerging data will hopefully contribute to attempts to prevent the development of UC -related CRC, e.g. through refining surveillance programmes. Details of the molecular heterogeneity of UC-related dysplasia and CRC may also help deve lop reliable tools for diagnosing the former and for predicting the behavio ur of the latter. Finally, there is increasing awareness of non-epithelial colorectal malignancies which are associated with UC and may potentially in crease in incidence with changes in the medical management of this inflamma tory disease.