Inflammatory Bowel Disease Neoplasia

IIBD confers an increased risk of intestinal cancer (1,2). Clinical management options are suboptimal and include lifelong intensive endoscopic biopsy surveillance versus prophylactic colectomy (3). These pose serious difficulties for patients and physicians alike, are inaccurate and expensive (3). Considering that approximately 90% of IIBD patients will never develop neoplasia, the great majority of these efforts are wasted. Better understanding of the earliest steps of UC tumorigenesis may uncover improved diagnostic markers to target the subset of patients at highest risk for cancer. Of at least equal importance, such markers could also save the large majority with limited risk from unnecessary procedures. Several molecular biomarkers show promise toward this end and will be reviewed.

Lecture Presenter
Mary Bronner, MD
Mary Bronner, MD
Division Chief, Anatomic Pathology and Oncology, ARUP Laboratories
Dr. Carl R. Kjeldsberg Endowed Chair in Pathology, University of Utah School of Medicine
Professor of Pathology, University of Utah School of Medicine

Dr. Bronner is the division chief of the Anatomic Pathology and Oncology divisions at ARUP and Carl R. Kjeldsberg presidential endowed professor of pathology at the University of Utah School of Medicine. Dr. Bronner received her MD from the University of Pennsylvania and completed her pathology residency training and chief residency at the Hospital of the University of Pennsylvania in Philadelphia. Dr. Bronner’s honors include her election as president of the GI Pathology Society, election as council member of the United States and Canadian Academy of Pathology, and, in 2005, the award of the Arthur Purdy Stout Prize, recognizing her work as a surgical pathologist under the age of 45 whose research publications have had a major impact on diagnostic pathology.

Dr. Bronner is an editorial journal board member for Human Pathology, The American Journal of Surgical Pathology, and Modern Pathology. She has served as an investigator on numerous NIH and foundation grants over the course of her career and has published over 100 peer-reviewed articles and numerous book chapters. Her research interests include molecular biomarkers for the early detection and prevention of gastrointestinal cancers arising in chronic inflammatory disorders of the intestine, stomach, liver, and pancreas, which together make up the most important causes of human cancer worldwide.

Objectives

After this presentation, participants will be able to:

Describe how current clinicopathologic risk markers of cancer risk in IIBD are insufficient.
Identify the optimal characteristics of a colonic IIBD risk marker.
Understand the available molecular biomarkers, particularly pre-clonal genomic markers such as FISH, telomere shortening, and anaphase bridges, along with gene hypermethylation and array nucleic acid technologies, in retrospective trials show promise as improved biomarkers.
Describe the concept of polypoid dysplasia in IIBD and how it is managed.
Understand how the various diagnoses of neoplasia in IIBD impact patient management.