Challenges in Crohn’s Disease Management after Gastrointestinal Cancer Diagnosis
Crohn’s disease (CD) is a chronic inflammatory bowel disease affecting both young and elderly patients, involving the entire gastrointestinal tract from the mouth to anus. The chronic transmural inflammation can lead to several complications, among which gastrointestinal cancers represent one of the most life-threatening, with a higher risk of onset as compared to the general population. Moreover, diagnostic and therapeutic strategies in this subset of patients still represent a significant challenge for physicians. Thus, the aim of this review is to provide a comprehensive overview of the current evidence for an adequate diagnostic pathway and medical and surgical management of CD patients after gastrointestinal cancer onset.
克罗恩病 (CD) 是一种影响年轻和老年患者的慢性炎症性肠病，涉及从口腔到肛门的整个胃肠道。慢性透壁炎症可导致多种并发症，其中胃肠道癌症是最危及生命的癌症之一，与一般人群相比，发病风险更高。此外，这部分患者的诊断和治疗策略仍然是医生面临的重大挑战。因此，本综述的目的是全面概述目前的证据，以便在胃肠道癌症发作后对 CD 患者进行适当的诊断途径以及内科和外科治疗。
Crohn’s disease (CD) is a chronic inflammatory bowel disease with a progressive course, potentially affecting the entire gastrointestinal tract from mouth to anus. Several studies have shown an increased risk of both intestinal and extra-intestinal cancer in patients with CD, due to long-standing transmural inflammation and damage accumulation. The similarity of symptoms among CD, its related complications and the de novo onset of gastrointestinal cancer raises difficulties in the differential diagnosis. In addition, once a cancer diagnosis in CD patients is made, selecting the appropriate treatment can be particularly challenging. Indeed, both surgical and oncological treatments are not always the same as that of the general population, due to the inflammatory context of the gastrointestinal tract and the potential exacerbation of gastrointestinal symptoms of patients with CD; moreover, the overlap of the neoplastic disease could lead to adjustments in the pharmacological treatment of the underlying CD, especially with regard to immunosuppressive drugs. For these reasons, a case-by-case analysis in a multidisciplinary approach is often appropriate for the best diagnostic and therapeutic evaluation of patients with CD after gastrointestinal cancer onset.
克罗恩病 (CD) 是一种慢性炎症性肠病，具有进行性病程，可能影响从口腔到肛门的整个胃肠道。几项研究表明，由于长期的透壁炎症和损伤积累，CD 患者患肠癌和肠外癌的风险增加。CD、其相关并发症和胃肠癌的新发症状之间的相似性增加了鉴别诊断的困难。此外，一旦对 CD 患者进行了癌症诊断，选择合适的治疗方法尤其具有挑战性。事实上，手术和肿瘤治疗并不总是与普通人群相同，由于胃肠道的炎症环境和 CD 患者胃肠道症状的潜在恶化；此外，肿瘤疾病的重叠可能导致潜在 CD 的药物治疗调整，尤其是在免疫抑制药物方面。由于这些原因，多学科方法中的个案分析通常适用于对胃肠道癌发病后 CD 患者的最佳诊断和治疗评估。
The diagnosis and treatment of gastrointestinal cancers in CD patients still represent a relevant challenge. An adequate evaluation of the risk factors, ad hoc surveillance and choosing the most appropriate treatment strategy are key factors for the long-term outcomes of these patients. This further underlines the importance of multidisciplinary management in such a challenging clinical condition. Further studies, in a randomized setting and involving a large sample size, are still needed to better define the best diagnostic and treatment pathways.
关键词： 克罗恩病,结直肠癌,小肠癌,肛门癌,多学科方法, Crohn’s disease, colorectal cancer; small bowel cancer,anal cancer,multidisciplinary approach,Show Figures