# Management of Inflammatory Bowel Disease with History of Cancer

## TL;DR

This review discusses the challenges of managing inflammatory bowel disease in patients with a history of cancer, focusing on cancer risk and treatment decisions.

## Contribution

The paper provides a comprehensive review of cancer risk and management strategies for IBD patients with cancer history, based on real-world evidence and guidelines.

## Key findings

- IBD patients have increased cancer risk, particularly colorectal cancer.
- Current management relies on expert consensus and real-world data due to lack of controlled trials.
- The paper outlines cancer risk factors and management clues for IBD patients with cancer history.

## Abstract

Crohn’s disease and ulcerative colitis, the main inflammatory bowel diseases (IBDs), have experienced rising prevalence worldwide, and their management is still challenging despite many therapeutic opportunities. Patients with IBDs have the same background risk of experiencing cancer but are also exposed to increased risk for some of them, i.e., colorectal cancer. A previous or current history of cancer is a dilemma for the IBD specialist since these patients are never included in a randomized controlled trial. Therefore, their management is based on multidisciplinary evaluation, expert consensus, and real-world experience. This review aims to clarify this situation and offer some clues on patient management.

Background/Objectives: Because of the chronic course of the disease, clinicians managing IBD frequently encounter patients with a prior or newly diagnosed cancer. This can be related to the specific background cancer risk in that subject, aging, familial/genetic factors, or ongoing chronic inflammation. However, a potential influence of some therapeutic agents should also be considered. This setting, in the absence of controlled trials and few open series reports available, raises issues such as correct screening, prevention, and surveillance, but also eventual modification or adaptation of the medical management. Methods and Results: Few consensus guidelines and studies are available on the management of IBD patients with a history of cancer, and therefore, we aim to review the recommendations of the current guidelines and the evidence reported in the most recent real-world cohorts. Conclusions: This review will offer (a) an understanding of the background of cancer risk in IBD patients; (b) analysis and discussion of the risk of cancer related to IBD therapy; and, finally, (c) some clues for the management of IBD in patients with a previous or current history of cancer.