What You Need to Know About Ulcerative Colitis and Colorectal Cancer

There is a significant link between ulcerative colitis (UC) and colorectal cancer. If you have UC, your risk of developing colorectal cancer is six times greater. And the longer you have had ulcerative colitis, the higher your risk for colon or rectal cancer becomes. Why are these two conditions of the intestines connected?

What is Ulcerative Colitis?

Ulcerative colitis is a chronic (long-term) inflammatory bowel disease that causes inflammation or swelling and ulcers in your large intestine, which is called the colon. The inflammation causes pain in the innermost lining of your intestines and rectum. Besides cancer, the inflammation caused by ulcerative colitis can cause complications such as arthritis, eye inflammation, liver disease, and osteoporosis. While there's no cure for UC, medications and lifestyle changes can calm the inflammation and help you live with the disease. In some cases, surgery is recommended. 

Most UC cases are diagnosed before age 30, although UC can happen at older ages. It occurs equally in men and women. Your risk of developing ulcerative colitis is higher if you:

• Have a close relative with inflammatory bowel disease
• Are between 15 and 30 years of age, or older than 60
• Are white or of Ashkenazi Jewish descent. Caucasians are at a higher risk than other races, except of Ashkenazi Jews who have an even higher risk level
• Eat a high-fat diet
• Frequently use NSAID medications (aspirin, ibuprofen, or naproxen) 

Ulcerative colitis symptoms vary depending on how severe the inflammation is and where it occurs. Some UC patients have mild, manageable symptoms or long periods of remission. Others have flare-ups (periods of active disease) with severe symptoms. 

Inflammation caused by ulcerative colitis can damage your colon lining and increase your risk of complications, including a higher risk of developing colorectal cancer.

Understanding Colorectal Cancer

Colorectal cancer develops from abnormal cells in the colon, rectum or both. Healthy cells can change (mutate), causing them to grow, accumulate and form a tumor. Colorectal cancer usually starts as a polyp – a small group of cells that develops on the lining of the colon or rectum. Some polyps are not cancerous, some are precancerous and can turn into cancer, and some already have early-stage cancer. When polyps are found early, they can be removed before they turn into cancer. 

Risk for Developing Colorectal Cancer

 Your risk of developing colorectal cancer increases if you:

• Have chronic inflammatory conditions such as ulcerative colitis or Crohn's disease
• Are over age 50, although it can start at any age
• Are a smoker
• Are a heavy alcohol drinker 
• Are African-American 
• Have a history of polyps
• Have a family history of colorectal cancer
• Eat a low-fiber, high-fat, high-calorie diet
• Don't get regular exercise
• Have diabetes
• Are overweight
• Had radiation therapy for cancer, especially in the pelvic area

How Does Ulcerative Colitis Increase the Risk of Colorectal Cancer?

Inflammation is what causes ulcerative colitis patients to have a higher risk of colorectal cancer. Chronic inflammation increases your colorectal cancer risk by:

• Damaging the genetic material in the cells of your colon, increasing the chances of mutations that become cancer
• Raising the levels of molecules that help cancer tumors grow
• Making infections more likely, which can interfere with your body's immune system and help cancer cells grow and multiply

If you have ulcerative colitis, your risk of developing colorectal cancer is higher if you have:

• A diagnosis of UC at a young age
• Had UC for more than eight years
• UC affects all or most of your colon
• Family history of UC, especially immediate family members
• A chronic condition that weakens your immune system, such as diabetes
• Had your appendix removed
• A diagnosis of precancerous cell damage
• Bile duct inflammation, damage, or scarring
• Uncontrolled inflammation from UC, the longer it is uncontrolled, the higher your risk

Ways to Reduce Your Risk of Ulcerative Colitis

Because of UC's link to colorectal cancer, it's important to reduce your risk of developing UC. And if you have a UC diagnosis already, there are things you can do to help reduce the flare ups that can happen.

These include:

• Managing your weight and eating a healthier diet.
• Reduce emotional stress – get enough sleep every night, exercise every day if you can, find healthy ways to reduce stress, and practice them every day.
• Use over the counter pain medications other than NSAIDs – try substituting NSAID meds with acetaminophen (Tylenol).
• Noticing any symptoms of ulcerative colitis when using antibiotics. 
• Quit smoking
• Start colorectal cancer screening earlier than someone who has average risk for colorectal cancer. 

Colorectal cancer is highly treatable when found early. Because ulcerative colitis patients are more likely to develop colon or rectal cancer, a regular screening schedule is critical. There are several ways colorectal cancer screening can be done. Talk with your doctor about what may be best for you.

What to Do If You Develop Colorectal Cancer

If you have UC and get a colorectal cancer diagnosis, request an appointment with a medical oncologist. Even though surgery may have removed the cancer, there can be invisible cancer cells that need to be treated in the colon and/or other areas of the body. The medical oncologist, together with the radiation oncology team and other experts at our cancer center, will develop an individualized colorectal cancer treatment plan for you. Be sure to talk about your history of ulcerative colitis when meeting with the oncologist. 

Request an appointment with one of our colorectal cancer specialists. We also offer second opinions for a cancer treatment plan you may have already received.