Eaden et al. (2001) conducted a meta-analysis of the researches that had been carried out on the topic of the probability of developing colon cancer as a continuation of ulcerative colitis. Given the fact that the results of different analyses differed greatly the aim of the authors was to remove the biases and get as precise data as possible.
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In their initial collecting of the available studies they found 194 studies of which they had to disregard 78 for the reasons such as reporting the cancer mortality data, including other diseases and not including background information (Eaden et al., 2001, p. 527). After that the attempt was to extract the information about incidence of colon cancer in populations previously diagnosed with ulcerative colitis, to check whether the cancer risk increased with the duration of disease and finally to investigate the impact of colectomy on the cancer risk.
The results obtained this way yielded much more certain information about the cancer risk in those populations. The overall risk of developing colon cancer once diagnosed with ulcerative colitis was established to be 3.7%. The increase of risk was noticed at ten year intervals. During the first ten years incidence is 2%, at twenty years the risk was determined to be 8% and at thirty years about 18% which represents a serious increase.
It was also established that the incidence of colon cancer in populations with ulcerative colitis varies geographically and that the highest incidence is in the US which is closely followed by UK and Scandinavian countries are least at risk. The attempts are made at explaining this fact by differences in diet but also various differences in dealing with cancer patients in terms of referral centers (Eaden et al., 2001, p. 533).
The final note which is particularly important for this purpose is that higher rate of colectomy did not, in fact, reduce incidence of cancer, it rather increased it. However, the authors concede that the increase might be a consequence of the fact that some centers which decide on surgery more often also have more rigorous surveillance strategies (Eaden et al., 2001, p. 531).
As far as the patient in the given scenario is concerned, on the basis of the data given in (Eaden at al., 2001), one can conclude that the best solution would definitely not be prophylactic colectomy for a number of reasons and alternative methods of treatment should be considered.
First in the line of reasons for such decision is related to the fact established by the article that more colectomies in a given population did not reduce the incidence of cancer (Kewenter et al., 1978)(Dennis & Karlson, 1961). This can give enough reasons to doubt any method of treatment. In addition to that, one must consider the psychological and social consequences for an individual living life with a stoma. It seems too radical a move to decide on such an aggressive treatment with so little to gain.
Secondly, the data given in the scenario presents an opportunity to estimate the patient’s risk of developing colon cancer. The fact that she was diagnosed at the age of twenty, that is as a young adult rather than child, excludes her from the category which seems to be at the greatest risk namely patients diagnosed with ulcerative colitis as children (Michener et al. 1961). In addition, 15-year long history of disease would place a patient in the group with the cancer risk between 2 and 8 % which is definitely too little to decide on the treatment with such difficult consequences. Furthermore, additional good sign is that she has had minimal symptoms during the last five years.
I would recommend that the patient continue with regular colonoscopies and pay attention to her diet which is definitely helpful in preventing colon cancer.
Dennis, C., & Karlson, K. E. (1961). Cancer risk in ulcerative colitis: formidability per patient-year of late disease. Surgery, 80, 568-571.
Eaden, J. A., Abrams, K. R., & Mayberry, J. F. (2001). Risk of colorectal cancer in ulcerative colitis. Gut, 48, 526-536.
Kewenter, J., Ahlman, H., & Hulten, L. (1978). Cancer risk in extensive ulcerative colitis.. Ann Surg, 188, 824-828.
Michener, W. M., Gage, R. P., & Sauer, W. G. (1961). The prognosis of chronic ulcerative colitis in children.. N Engl J Med, 265, 1075-1079.