Riesgo de cáncer colorrectal en la CU

Los pacientes con colitis ulcerativa tienen un riesgo más alto de padecer cáncer colorrectal que la población general. Este riesgo es relacionado con la extensión y duración de la enfermedad, pero no con su actividad.

A continuación se describen las estrategias de vigilancia para evitar el cáncer colorrectal. Recordemos que éstos no son más que normas generales que deben ser interpretadas en forma individual en cada paciente.

Indicaciones de vigilancia para cáncer colorrectal en colitis ulcerativa 

1. Colitis ulcerativa por 8 o más años.
2. Colitis ulcerativa del lado izquierdo por 15 años o más.
3. Proctitis: screening y seguimiento de acuerdo a los parámetros de la población general.
4. Colangitis esclerosante primaria; comenzar vigilancia en el momento del diagnóstico.

Técnica. Se realiza una colonoscopia hasta el ciego tomando al menos 33 biopsias jumbo o biopsias en 4 cuadrantes cada 10 cms.

Hallazgos y conducta a seguir. 

1. Sin displasia. Repetir vigilancia en 1 ó 2 años.
2. Indefinido para displasia. Se trata la inflamación activa y se repite vigilancia en 6 meses.
3. Displasia plana. Aquí es importante confirmarla por un segundo patólogo, hay controversia cuando se trata de una displasia de bajo grado debido a la dificultad para distinguir entre atipia reactiva y ésta. Algunos pacientes desean seguir sometidos a vigilancia y se recomienda en este caso seguirlos a 6 meses. Otro grupo es partidario de realizar colectomía. Cuando se trata de una displasia de alto grado se recomienda colectomía definitivamente.
4. Lesión displásica o masa. Cuando se trata de una lesión o masa asociada con displasia (LMAD) se recomienda colectomía. Si se encuentra un adenoma característico se procederá a la polipectomía; si en el estudio histológico se encuentra displasia en la mucosa adyacente se indica la colectomía. Y si no hay displasia en la mucosa adyacente el paciente se someterá a vigilancia a un año (77, 82,83).

Prevención del cáncer en la EC 

Mucho menor es la atención dedicada a reducir el riesgo de un cáncer colorrectal en los pacientes con EC. Muchos de ellos han sido sometidos a resecciones de la parte afectada del colon, con lo que el riesgo quedaba reducido.

Dada la naturaleza irregular de la EC, una colectomía total raras veces estará justificada en ausencia de una afectación cólica total. Se recomienda la inclusión de los pacientes con una colitis de Crohn de larga duración en los programas de vigilancia del cáncer aunque se reconoce que se disponen de pocos datos en apoyo a esta recomendación (82).

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