As a follow up on my earlier thread on crohns migrating post jpouch.... Granted that I am currently dx'd as UC (have been considered indeterminate for a time), but I'm curious: what is normally done in terms of surgery recommendations for dysplasia/ cancer risk for crohns colitis cases?

Is total colectomy still normally the practice for high cancer risk with CC, and then one simply deals with the possibility of crohn's migrating to the ileum?

Christopher (?UC)

Although the goal with Crohn's is preservation of the bowel, for Crohn's colitis the surgery of choice is the same as for UC, total colectomy. Sometimes the rectum can be spared in rare cases where the rectum is not affected, but if there is any rectal disease, total proctocolectomy is the standard. There is a lot of disagreement regarding the j-pouch for Crohn's colitis and in select cases it can be appropriate. However, there are also surgeons who would never do it because of the significant risk of Crohn's disease of the pouch. Apparently, Crohn's disease tends to recur upstream of a surgical site, plus having a reservoir increases the risk.

Jan

Thanks, Jan. Apart from the risk of it being CC and not UC, my other big concern re. pouch is the fact that one dysplasia biopsy was in the rectum. I'll cross these bridges when the time comes, talking to surgeons I guess, and see how my next scope goes before making the really big decisions. Hoping like most of you have done, to try for a pouch and hope for the best.

Christopher

If you doctor says you have UC, not crohn's then I personally would get a Jpouch surgery. Otherwise I would always be thinking, "what if"?.

If later down the road it turns into crohn's then you will need to deal with it at that time.

When were you diagnosed with dysplasia? Was it low/high grade? I had this surgery too due to the discover of dysplasia during a routine colonoscopy. What grade is it? Indeterminite/Low/High grade?

If it is high grade, and even low grade, I would start speaking to your surgeons sooner than later. My understanding is that 50% of people with UC - dysplasia found in a colonoscopy actually had cancer found on the colon. I was one of them. Luckily, it was found early enough where surgery was the only treatment needed. The longer you wait, the more risk involved.

Even for those with rectal cancer, pelvic pouch surgery is possible with the use of low anterior resection. So, do not assume that rectal dysplasia is a contraindication for the j-pouch. Obviously, you would need to have regular follow up scopes and biopsies.

Jan

The dysplasia was low grade, and the GI consensus is that it only wrrants increased surveillance (6 months interval) at this time. I absolutely want to wait at least until the next scope before making any life changing decisions like surgery, but I am mentally prepared to go for the gold. Well, 6 months is only 4 months now as the scope was 2 months ago, so we'll see.

Christopher

CCFA (Crohns and Colitis Foundation of America) has 3 wonderful webcasts/videos that have top GI's discussing Colorectal Cancer and IBD. Very Informative!!

http://wm.world.mii-streaming.net/media/ccfa/March%2020...gi_ibdcancer_320.asf

http://wm.world.mii-streaming.net/media/ccfa/March%2020.../gi_ibdchemo_320.asf

http://wm.world.mii-streaming.net/media/ccfa/March%2020...i_ibdpatient_320.asf

OR if these dont work

http://www.ccfa.org/webcast/colorectalcancer