Carcinoma in inflammatory bowel disease: endoscopic advances, management, and specimen handling. A review for the pathologist

Inflammation plays a major role in the development of carcinomas in IBD. The previous role of stromal cells has probably been underestimated in the past. In general treatment regimens aim to reduce the inflammation to prevent carcinoma. Endoscopy and histopathology play a major role not only in diagnosis of neoplasia but also in removal and staging and have to follow strict steps to ensure high quality. At our institution about 90% of all carcinomas in IBD are cases of ulcerative colitis. Therefore, we focus on the present manuscript more on ulcerative colitis rather than carcinoma in Crohn's disease. Sometimes outside from specialized centres partial colectomies are carried out in cases with carcinomas in ulcerative colitis instead of performing complete proctocolectomies. Our retrospective data show that there is a higher risk for relapses from lymph node metastasis but also for metachronous lesions. The survival rates are almost comparable but complete colectomies are still the treatment of choice for carcinomas in ulcerative colitis.