A 40-year-old man with a 15-year history of ulcerative colitis presents for a routine follow-up. His disease has been well-controlled on mesalamine, and he has been asymptomatic for the past several years. His medical history is otherwise unremarkable, and there is no family history of colorectal cancer. Vital signs are within normal limits. On physical examination, he appears healthy, and abdominal examination is benign.
Which of the following is the most appropriate regarding colorectal cancer surveillance for this patient?
A) Colonoscopy now and every 1-3 years thereafter
Patients with ulcerative colitis are at increased risk for colorectal cancer, and the risk is related to the duration and extent of the disease. Surveillance colonoscopy should begin 8 years after diagnosis and be repeated every 1-3 years thereafter, regardless of disease control.
Answer choice B: Colonoscopy now and every 5 years thereafter, is incorrect. A 5-year interval is too long for patients with ulcerative colitis due to the increased risk of colorectal cancer.
Answer choice C: Prophylactric colectomy with ileal pouch, is incorrect. Prophylactic colectomy is not indicated in patients with well-controlled disease and no evidence of dysplasia.
Answer choice D: Surveillance colonoscopy starting at age 45 years, is incorrect. Surveillance should start earlier, typically 8 years after diagnosis, not at age 45.
Answer choice E: No further surveillance is needed, is incorrect. Surveillance is essential even if the disease is well-controlled, due to the increased risk of colorectal cancer.
Key Learning Point
In patients with ulcerative colitis, surveillance colonoscopy should begin 8 years after diagnosis and be repeated every 1-3 years due to the increased risk of colorectal cancer, regardless of disease control.
