What to Know About Crohn’s Disease and Colorectal Cancer

Crohn’s disease is a form of inflammatory bowel disease (IBD) that can develop in any part of your gastrointestinal (GI) tract, but it most commonly affects the small and large intestines.

Crohn’s and other forms of IBD are associated with an increased risk of developing cancer in your colon or rectum, also called colorectal or bowel cancer.

However, Crohn’s disease itself is not a cancer. The majority of people with Crohn’s do not develop cancer.

We’ll explore what we know so far about the chances of colorectal cancer in people with Crohn’s disease, other health complications, treatment, and more.

Colorectal cancer is one of the complications associated with Crohn’s and other forms of IBD.

In colorectal cancer, abnormal cells (called oncogenes) grow in the colon or rectum, multiplying uncontrollably. These cells form malignant, or cancerous, tumors. Over time, the cancer cells can spread through the lining of the GI tract and travel to other parts of the body.

Long-term inflammation is the primary link between Crohn’s disease and an increased risk of cancer. Over time, chronic inflammation from Crohn’s can cause high cell turnover on the lining of your GI tract. As your cells constantly become damaged and replaced, this raises the likelihood of cell mutation.

Researchers in a 2014 study analyzed data from more than 800 Australian people with Crohn’s or ulcerative colitis from 1977 to 1992. Among those with Crohn’s disease, 1 percent had developed colorectal cancer after 10 years, rising to 2 percent by 30 years.

This number was higher in people with ulcerative colitis, where the 30-year likelihood of cancer was 7 percent. According to the National Cancer Institute (NCI), the lifetime rate of colorectal in the general US population is around 4 percent,

While it appears people with IBD have an increased risk of colorectal cancer, this risk is much more associated with ulcerative colitis than with Crohn’s disease.

Length of disease is the most important indicator of increased risk. People who have had IBD for decades have significantly higher chances of colorectal cancer than the general population.

Some forms of Crohn’s are more severe than others, and these differences may affect cancer risk. For example, some people have Crohn’s disease that only affects the small bowel and not the colon.

When your digestive tissues become inflamed during Crohn’s disease, you can experience physical symptoms, such as:

  • diarrhea
  • cramping
  • blood in your stool
  • fatigue
  • weight loss
  • difficulty controlling bowel movements

Read more about other ways Crohn’s disease affects the body.

Signs and symptoms of colorectal cancer can look similar to the general symptoms of Crohn’s disease or ulcerative colitis. Let’s go over how colorectal cancer can start and what it looks like.

In the colon or rectum, sometimes polyps (growths made of cells) develop on the tissue lining. These can vary in size and appearance, like being flat or raised. Polyps can occur naturally as you age, and the majority will never become cancerous. However, most colon cancers do begin as polyps.

The two types of polyps associated with colorectal cancer are adenomas and sessile serrated lesions (a type of hyperplastic polyp). These polyps aren’t inherently cancerous but can become so. The most common type of cancerous tumor in colorectal cancer is called an adenocarcinoma.

According to the Centers for Disease Control and Prevention (CDC)common symptoms of colorectal cancer include:

  • diarrhea and constipation
  • feeling your bowels aren’t emptying all the way
  • blood in your stool
  • abdominal pain or cramping
  • unexplained weight loss

Colorectal cancer may not have any symptoms, especially in its early stages. This is why screening measures are so important.

Regardless of whether you have IBD or not, if you’re experiencing a sudden change in bowel activity, talk with a doctor. There are multiple reasons you may be experiencing these symptoms, including infection and food allergy. Prompt evaluation can get you on the path to treatment.

A number of medications and therapies can treat Crohn’s disease. Some medications used to treat mild to moderate Crohn’s disease include:

Biologic medications for Crohn’s disease

In more severe forms of the disease, a doctor may prescribe a combination of immunomodulators and biologics.

Biologics are a newer class of medications that are created using proteins naturally found in the body. These proteins work on specific parts of your immune system. They are especially effective in fighting inflammatory diseases.

Some examples of biologics used to treat Crohn’s disease include:

  • infliximab (Remicade)
  • adalimumab (Humira)
  • golimumab (Simponi)
  • vedolizumab (Entyvio)

Work with your doctor to create a plan of care for your Crohn’s that you’re comfortable with. Treatment options will depend on the severity of your condition and other individual health factors.

Surgery for Crohn’s disease

In severe forms of Crohn’s, including when cancer is involved, surgery may be needed.

Surgery is relatively common for people who have had Crohn’s for a long time. Researchers in one 2012 study reviewed 310 cases of Crohn’s disease diagnosed between 1970 and 2004. They found that overall, there was a 60 percent probability people needed major abdominal surgery after 20 years of having the disease.

A 2014 study found around 50 percent of people with Crohn’s needed surgery within 30 years after diagnosis.

Surgical procedures for Crohn’s and other forms of IBD may be used to:

In some cases, you may need to have sections of your colon or bowel removed. The surgeon will always aim to preserve as much of your intestines as possible.

Learn more about types of surgery for Crohn’s disease.

Getting emotional support

Living with a chronic condition cause both physical and emotional stress. You deserve a support network to help you cope with your IBD and process your experiences.

Consider reaching out to a mental health therapist. Therapy can help you work on coping skills, identify toxic thought or behavior patterns, and provide a safe space to talk about whatever you need to.

Here are some resources to get started:

According to the National Institutes of Health (NIH)there are other significant risk factors that contribute to your chance of developing colorectal cancer besides having IBD.

These include:

  • family history of colorectal cancer
  • having obesity
  • smoking cigarettes
  • misusing alcohol
  • not getting enough exercise

Managing your Crohn’s disease and getting regular screening for colorectal cancer is the best way to prevent complications.

Health priorities for people with IBD include:

In 2021, the US Preventive Services Task Force (USPSTF) issued new guidelines regarding recommendations for screening for colorectal cancer.

The expert organization recommends screening should start at age 45 for everyone. This even applies to adults who don’t have any preexisting risk factors for colorectal cancer, including IBD.

Cancer screening strategies include:

  • Stool tests. Different stool sample tests can detect blood, antibodies, and altered DNA. Following your doctor’s instructions, you usually collect stool samples at home using a provided kit.
  • Colonoscopy. In a colonoscopy procedure, your doctor inserts a thin, flexible tube with a light on the end into your rectum to evaluate your colon’s health. You will eat a special liquid diet leading up to your colonoscopy and be sedated during the procedure so you don’t feel pain. Colonoscopy is used to help diagnose complications of IBD and identify precancerous tissues or early cancer.
  • Flexible sigmoidoscopy. Similar to a colonoscopy, this procedure takes a close look at the lower third of the colon (sigmoid).
  • CT colonography (virtual colonoscopy). This uses X-rays to produce a digital image of your entire colon on a computer.

If you have Crohn’s or another form of IBD, you likely should be screened more frequently. The USPSTF recommends colonoscopy for people ages 45 and over every 10 years.

However, the Crohn’s and Colitis Foundation recommends people who have had Crohn’s disease for at least 8 years to have a colonoscopy every 1 to 2 years.

Learn more about your screening options for colorectal cancer.

Crohn’s disease is a serious inflammatory condition that can reduce your quality of life when not treated well. It can create a host of uncomfortable symptoms, like diarrhea and a loss of bowel control.

Perhaps more serious, however, is the increased risk of people with Crohn’s disease have of developing certain cancers.

If you have Crohn’s disease, talk with your doctor about the best treatment plan to manage inflammation and when to have screenings for complications like cancer. Cancers that are identified and treated early are usually the easiest to treat.

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