We have reviewed eight cases of
Crohn's disease associated
carcinoma (
CDAC) of the bowel treated at Saint Barnabas Medical Center since 1977. Five patients had
colorectal carcinoma in areas of dysplasia within histologically recognizable
Crohn's disease. One of the large bowel
carcinomas was a diffusely infiltrating signet ring
adenocarcinoma (
linitis plastica), three were
mucinous carcinomas, and one contained both cell types. Survival ranged from 4 to 55 months. Three patients developed ileal
carcinomas in areas of dysplasia within histologically recognizable
Crohn's disease. One of the
ileal cancers was a moderately differentiated
adenocarcinoma; two were poorly differentiated
adenocarcinomas. Survival ranged from 8 to 44 months. The dysplastic changes seen in the bowel adjacent to the
tumors in these patients were identical to the characteristic pre-cancerous (dysplastic) changes well described in
ulcerative colitis. The histopathologic changes seen in this high-risk group of patients are also similar to those of previously reported
CDAC. Those patients with the more diffuse dysplastic changes might have been detected before the development of invasive
cancer had they undergone periodic colonoscopic surveillance. One patient in the series with an asymptomatic lesion was, in fact, identified at surveillance colonoscopy. It would appear that
Crohn's disease patients have a similar risk for
carcinoma previously recognized in
ulcerative colitis patients and that surveillance protocols should be developed for this group of patients.