Ulcerative Colitis Doubles Your Colon Cancer Risk: What to Know to Protect Yourself

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Texting and driving. Salami and ketchup. That old bull in the china shop.

Some things are just scary together. So it is with ulcerative colitis and colon cancer.

Ulcerative colitis is an inflammatory bowel disease, a category of chronic conditions (another is Crohn’s) that involves swelling within the digestive tract. The primary cause: an immune system run amok, attacking healthy cells in the large intestine instead of foreign invaders like viruses and bacteria.

This friendly fire leads to persistent irritation, swelling, and sores in the inner lining of the intestine, causing abdominal pain, bloody diarrhea, and an urgent need to find a toilet.


Many patients can control ulcerative colitis symptoms with prescription meds, clean eating, or surgery. However, all patients need to be hyper-vigilant about colorectal cancer.

If you have ulcerative colitis, your overall risk of colon cancer is 2.4 times higher than that of the general population, according to a study published in April 2016 in the journal Digestive Endoscopy. To compare, if you don’t have ulcerative colitis, your risk is less than 5 percent.

If you have ulcerative colitis and are concerned about cancer, here are eight things to keep in mind and discuss with your doctor.


The Longer You Have Ulcerative Colitis, the Higher Your Risk

Chronic inflammation in the gastrointestinal tract can cause dysplasia, changes in the cells that line your colon that can lead to cancer, according to the Crohn’s & Colitis Foundation (CCF).

Your colon cancer risk starts to increase once you’ve lived with ulcerative colitis for eight to 10 years. What’s more, the longer you have the condition, the higher it climbs.

“It could be as high as 20 percent if you have the disease for 30 years,” says gastroenterologist Adam Ehrlich, M.D., co-medical director of the inflammatory bowel disease program at Temple University in Philadelphia. “And most people are diagnosed fairly young.”

The median age of diagnosis is 34.9, according to CCF.


Microscope photo of a human large intestine section with inflammation
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Your Risk Varies by How Much Colon is Affected

People with ulcerative colitis that’s confined to the rectum—or the rectum and sigmoid colon, the part of the large intestine closest to the rectum—aren’t at greater risk for colorectal cancer than the general population, says Dr. Ehrlich.

Increased risk occurs when the inflammation goes higher, affecting the ascending, descending, and transverse colons.


Your Risk for Other Cancers May Be Higher, Too

Patients with inflammatory bowel disease, including ulcerative colitis, have an elevated risk of skin cancer and lymphoma as well, possibly because the medications used to treat ulcerative colitis suppress the immune system, says Dr. Ehrlich.

Talk to your doctor about the best ways to monitor yourself for these tagalong diseases.


Ulcerative Colitis Can Mimic Colon Cancer

An ulcerative colitis flare-up can cause blood in your stool, which is also a red flag for colorectal cancer. Talk to your doctor if any of these symptoms make a sudden appearance:

  • Narrow, bright red, or very dark stools
  • A change in how often you’re having bowel movements
  • Constant fatigue
  • Recurring and unexplained vomiting
  • Increased instances of diarrhea or constipation


You Need to Know Your Family History

Among those with ulcerative colitis, not all cancer risk is the same.

A family history of colorectal cancer doubles your odds of getting the disease, according to a study in the World Journal of Gastroenterology, as compared to patients without a family history.

Tell your doctor if you have a family history of colorectal cancer; familial adenomatous polyposis, a condition in which the intestine is lined with benign polyps; or Lynch syndrome, a genetic disorder characterized by polyps in the colon.

All raise your cancer risk.


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Never Skip a Regular Screening

People who have ulcerative colitis that extends past the sigmoid colon should start annual colonoscopies—a test where doctors use a long, flexible tube with a camera attached to inspect the inside of the colon—no later than eight years after symptoms appear, says Dr. Ehrlich.

Your doctor may also take a biopsy during your screening, especially if he or she notices dysplasia or cells that look cancerous.

If you’ve previously had dysplasia or a bile duct inflammation called primary sclerosing cholangitis, your physician may spray a blue dye onto the colon walls to spot cancerous areas more easily.


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If You Have Dysplasia, Consider Having Your Colon Removed

Patients with high-grade dysplasia may need to have a colectomy, a surgical procedure to remove some or all of the colon.

However, if the dysplasia is low-grade, the bumps and nodules can often be completely taken out during a colonoscopy.

Doctors may also choose to monitor low-grade dysplasia with more frequent colonoscopies (every six months) to see if the inflammation regresses with treatment, says Dr. Ehrlich.


Your Overall Risk Is Dropping

Finally, good news! Dr. Ehrlich says that among patients with ulcerative colitis, colon cancer rates are actually going down.

“Fewer people are developing cancer because our treatments for ulcerative colitis have gotten much better,” he says.

The bottom line: If you have ulcerative colitis, work with your physician to find the medication and screening schedule that works for you.