E4650. Imaging Manifestations of Intestinal and Extra-Intestinal Malignancies in Patients with Inflammatory Bowel Disease
Authors
Mohammadreza Shaghaghi;
Johns Hopkins Hospital
Rakhee Gawande;
Johns Hopkins Hospital
Background
Inflammatory bowel disease (IBD) is a chronic inflammatory condition of the gastrointestinal tract that includes ulcerative colitis, Crohn's disease, and microscopic colitis, a less well-known type. Patients with IBD are at increased risk of colorectal and extra-intestinal malignancies. Despite established screening guidelines in colorectal cancer screening, there is limited information on the imaging of other types of malignancies in these patients. On the other hand, cancer diagnosis could be challenging in these cases due to chronic inflammatory changes. Radiologists’ awareness about the alarming imaging findings could play a crucial role in early cancer detection and improving the patients’ outcomes.
Educational Goals / Teaching Points
Colorectal cancer is the most common type of cancer associated with IBD, with a risk about two to three times higher than that in the general population in patients with ulcerative colitis. However, the risk of other noncolorectal malignancies is also elevated compared to the general population due to chronic inflammation or the immunosuppressed state related to IBD treatment. These malignancies include: (1) small bowel cancer, which carries a 10-times higher risk; (2) lymphoma, which presents a 20-times higher risk; (3) cholangiocarcinoma, associated with a 2-times higher risk; (4) gastric cancer, showing a 1.5–2-times higher risk; (5) perianal/vulvovaginal squamous cell carcinoma (risk level unknown); And (6) melanoma and cervical cancer, linked to an immunosuppressed status. Diagnosing cancer in these patients cannot rely solely on colonoscopy, it primarily depends on imaging and clinical findings.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The following imaging manifestations should raise suspicion about noncolorectal malignancies in patients with IBD, that should warrant additional imaging or clinical evaluation. (1) Masslike small bowel wall thickening, with or without obstructive symptoms, especially in the absence of strictures. (2) Gastric wall thickening, especially with evidence of gastric outlet obstruction. (3) Vulvovaginal skin/mucosal thickening. (4) Biliary dilation or liver capsular retraction. (5) Oropharyngeal mucosal thickening or ulceration. FDG-PET scan, contrast-enhanced MRI, and/or tissue biopsy could be the next step modalities after the initial imaging presentation.
Conclusion
Patients with IBD are at increased risk of colorectal and noncolorectal malignancies, due to chronic inflammation and also immunosuppression-related to IBD treatment. Cancer diagnosis might be even more challenging due to chronic inflammatory changes in the tissue. The course of cancer treatment could also be more complicated in these patients than in general population. Rising radiologists’ awareness about the alarming imaging findings could play a crucial role in early cancer detection and improving the patients’ outcomes.
