# Navigating Neoplasm Risk in Inflammatory Bowel Disease and Primary Sclerosing Cholangitis

## TL;DR

People with inflammatory bowel disease and primary sclerosing cholangitis face a high cancer risk, especially for colorectal and bile duct cancers, and new diagnostic tools are helping detect these cancers earlier.

## Contribution

The paper reviews recent molecular insights and diagnostic advancements for managing cancer risk in patients with IBD and PSC.

## Key findings

- PSC-IBD patients have a 10-fold higher risk of colorectal cancer and over 20% lifetime risk of cholangiocarcinoma.
- Annual colonoscopy and CA 19-9 monitoring are recommended for CRC and CCA surveillance.
- Molecular diagnostics and imaging technologies are improving early cancer detection in this high-risk group.

## Abstract

Individuals with both inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC) are at a markedly elevated risk for cancer, particularly colorectal cancer (CRC) and cholangiocarcinoma (CCA). While the reasons behind this increased susceptibility remain poorly understood, growing evidence points to the involvement of molecular mechanisms, including microbiota-driven inflammation, bile acid dysregulation, and immune-mediated injury. This review explores emerging insights into cancer pathogenesis and highlights recent progress in diagnostic and preventive strategies. Current recommendations include annual colonoscopy for CRC and imaging combined with CA 19-9 monitoring for CCA. New molecular and imaging tools are transforming early detection and risk management in PSC-IBD patients.

(1) Background and Aims: Patients with inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC) face a significantly increased risk of malignancies, including a 10-fold higher risk for colorectal cancer (CRC) and a lifetime risk for cholangiocarcinoma (CCA) exceeding 20%. The mechanisms underlying this elevated risk remain elusive. This review consolidates recent findings on cancer risk in PSC-IBD patients, focusing on molecular pathways, diagnostic innovations, and prevention strategies. (2) Methods: A comprehensive PubMed search was performed to identify studies published through to March 2025 on oncogenic processes, molecular mechanisms, and advancements in diagnostic and preventive strategies for CRC and CCA in PSC-IBD patients. (3) Results: Surveillance guidelines recommend an annual colonoscopy for CRC and imaging combined with CA 19-9 monitoring for CCA. Recent studies highlight the role of molecular alterations, including epigenetic modifications, in tumorigenesis. Advances in molecular diagnostics, imaging, and endoscopic technologies are improving the accuracy and timeliness of cancer detection. (4) Conclusions: PSC-IBD patients remain at high risk for CRC and CCA, emphasizing the need for vigilant surveillance and advanced prevention strategies. Advances in early detection and precision diagnostics offer new opportunities to reduce the cancer burden in this high-risk population.