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Challenges in Crohn’s Disease Management after Gastrointestinal Cancer Diagnosis

胃腸癌診斷后克羅恩病管理的挑戰(zhàn)

Crohn’s disease (CD) is a chronic inflammatory bowel disease affecting both young and elderly patients, involving the entire gastrointestinal tract from the mouth to anus. The chronic transmural inflammation can lead to several complications, among which gastrointestinal cancers represent one of the most life-threatening, with a higher risk of onset as compared to the general population. Moreover, diagnostic and therapeutic strategies in this subset of patients still represent a significant challenge for physicians. Thus, the aim of this review is to provide a comprehensive overview of the current evidence for an adequate diagnostic pathway and medical and surgical management of CD patients after gastrointestinal cancer onset.

克羅恩病 (CD) 是一種影響年輕和老年患者的慢性炎癥性腸病，涉及從口腔到肛門(mén)的整個(gè)胃腸道。慢性透壁炎癥可導(dǎo)致多種并發(fā)癥，其中胃腸道癌癥是最危及生命的癌癥之一，與一般人群相比，發(fā)病風(fēng)險(xiǎn)更高。此外，這部分患者的診斷和治療策略仍然是醫(yī)生面臨的重大挑戰(zhàn)。因此，本綜述的目的是全面概述目前的證據(jù)，以便在胃腸道癌癥發(fā)作后對(duì) CD 患者進(jìn)行適當(dāng)?shù)脑\斷途徑以及內(nèi)科和外科治療。

三角細(xì)胞搖瓶

Crohn’s disease (CD) is a chronic inflammatory bowel disease with a progressive course, potentially affecting the entire gastrointestinal tract from mouth to anus. Several studies have shown an increased risk of both intestinal and extra-intestinal cancer in patients with CD, due to long-standing transmural inflammation and damage accumulation. The similarity of symptoms among CD, its related complications and the de novo onset of gastrointestinal cancer raises difficulties in the differential diagnosis. In addition, once a cancer diagnosis in CD patients is made, selecting the appropriate treatment can be particularly challenging. Indeed, both surgical and oncological treatments are not always the same as that of the general population, due to the inflammatory context of the gastrointestinal tract and the potential exacerbation of gastrointestinal symptoms of patients with CD; moreover, the overlap of the neoplastic disease could lead to adjustments in the pharmacological treatment of the underlying CD, especially with regard to immunosuppressive drugs. For these reasons, a case-by-case analysis in a multidisciplinary approach is often appropriate for the best diagnostic and therapeutic evaluation of patients with CD after gastrointestinal cancer onset.

克羅恩病 (CD) 是一種慢性炎癥性腸病，具有進(jìn)行性病程，可能影響從口腔到肛門(mén)的整個(gè)胃腸道。幾項(xiàng)研究表明，由于長(zhǎng)期的透壁炎癥和損傷積累，CD 患者患腸癌和腸外癌的風(fēng)險(xiǎn)增加。CD、其相關(guān)并發(fā)癥和胃腸癌的新發(fā)癥狀之間的相似性增加了鑒別診斷的困難。此外，一旦對(duì) CD 患者進(jìn)行了癌癥診斷，選擇合適的治療方法尤其具有挑戰(zhàn)性。事實(shí)上，手術(shù)和腫瘤治療并不總是與普通人群相同，由于胃腸道的炎癥環(huán)境和 CD 患者胃腸道癥狀的潛在惡化；此外，腫瘤疾病的重疊可能導(dǎo)致潛在 CD 的藥物治療調(diào)整，尤其是在免疫抑制藥物方面。由于這些原因，多學(xué)科方法中的個(gè)案分析通常適用于對(duì)胃腸道癌發(fā)病后 CD 患者的最佳診斷和治療評(píng)估。

細(xì)胞轉(zhuǎn)瓶

The diagnosis and treatment of gastrointestinal cancers in CD patients still represent a relevant challenge. An adequate evaluation of the risk factors, ad hoc surveillance and choosing the most appropriate treatment strategy are key factors for the long-term outcomes of these patients. This further underlines the importance of multidisciplinary management in such a challenging clinical condition. Further studies, in a randomized setting and involving a large sample size, are still needed to better define the best diagnostic and treatment pathways.

細(xì)胞培養(yǎng)板

CD患者胃腸道癌癥的診斷和治療仍然是一個(gè)相關(guān)的挑戰(zhàn)。對(duì)風(fēng)險(xiǎn)因素的充分評(píng)估、特別監(jiān)測(cè)和選擇最合適的治療策略是這些患者長(zhǎng)期預(yù)后的關(guān)鍵因素。這進(jìn)一步強(qiáng)調(diào)了在如此具有挑戰(zhàn)性的臨床條件下多學(xué)科管理的重要性。仍然需要在隨機(jī)環(huán)境中并涉及大樣本量的進(jìn)一步研究，以更好地確定最佳診斷和治療途徑。

關(guān)鍵詞： 克羅恩病,結(jié)直腸癌,小腸癌,肛門(mén)癌,多學(xué)科方法, Crohn’s disease, colorectal cancer; small bowel cancer,anal cancer,multidisciplinary approach,Show Figures

來(lái)源：MDPI https://www.mdpi.com/2072-6694/13/3/574/htm