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Johns Hopkins Pediatric

Pathology Clue Could Be a Link Between IBD and Cancer

Alyssa Parian, MD

Alyssa Maria Parian, M.D.

Trying to determine the link between a particular pathology finding and colorectal cancer in patients with inflammatory bowel disease (IBD), Alyssa Parian and several Johns Hopkins colleagues performed a retrospective observation study.

Patients with the IBDs of chronic ulcerative colitis or Crohn’s disease are at increased risk of colorectal cancer. Parian says that, like all cancers, the best treatment is early detection—or even before cancer develops.

“That’s why we monitor our IBD patients as closely as we do with colonoscopies every one to two years,” says Parian. “When we take biopsies we’d like there to be a specific marker to determine which patients will develop colon cancer and what we should do.”

Since it was consistently recognized in 2000 by the Johns Hopkins pathology department, researchers have suspected the pathology finding of serrated epithelial change (SEC) could be a harbinger of dysplasia. But the link has been difficult to prove.

Parian’s retrospective study looked at 187 Johns Hopkins Hospital patients whose IBD diagnoses were at least 15 years old.

“The results suggest that there may be an association between SEC and dysplasia in IBD patients,” Parian says. “In our study, patients with recurrent findings of SEC on biopsies were more likely to develop dysplasia.”

She adds that patients with IBD with poorly controlled chronic inflammation, longer duration of disease and a concomitant diagnosis of primary sclerosing cholangitis were more likely to develop dysplasia.

Parian believes the Johns Hopkins study is the largest study yet to look at SEC and the risk of dysplasia in those with IBD.

Still, she says, the topic needs more research. “The association between SEC and dysplasia remains just that; no path of causality has been delineated.” She is involved in further controlled studies comparing the rates of dysplasia in patients with IBD with SECs and those with IBD without SECs.

Parian also notes some evidence of a unique genetic pathway for serrated lesions in IBD. “I think that’s where we’ll find some more definitive answers to this question.”

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