Search tips
Search criteria 


Logo of gutGutView this articleSubmit a manuscriptReceive email alertsContact usBMJ
Gut. 1988 February; 29(2): 206–217.
PMCID: PMC1433302

Colorectal cancer in ulcerative colitis: a cohort study of primary referrals from three centres.


A retrospective cohort of 823 patients with ulcerative colitis who resided at the time of diagnosis in one of three defined geographical areas (West Midlands region, Oxford region, England and Stockholm County, Sweden) was assembled. The patients were first seen at named hospitals in these areas and the diagnosis of ulcerative colitis established within five years of onset of symptoms between 1945-1965. All patients were 15 years of age or more at onset of disease and were followed for a minimum of 17 years and a maximum of 38 years. Ninety seven per cent completeness of follow up was achieved. Examining the colorectal cancer risk in the series relative to the risk in the general population by standardised morbidity ratios, there was an eight fold increased risk of cancer in the series as a whole. Dividing the series by extent of colitis, extensive colitis patients showed a 19 fold increase in risk. A four fold increased risk was shown in the remainder of the series (left sided colitis, proctitis and extent unknown). Life table analyses in extensive colitis gave cumulative risks of 7.2% (CI 3.6-10.8) at 20 years from onset of disease and 16.5% (CI 9.0-24.0) at 30 years from onset. No significant effect of age at onset, sex or referral centre could be detected. Examination of the data by interval from onset to cancer and by actual age at development of cancer suggests that patients who develop colorectal cancer will do so in a distribution around 50 years of age independent of duration of disease in adult onset ulcerative colitis (greater than 15 years at onset of disease). An inverse relationship was shown between age at onset of disease and interval from onset of disease to cancer. Further age specific rates for cancer increased up to 50 years and decreased thereafter. These results suggest that extensive colitis patients have a genetic predisposition to colorectal cancer and that longstanding inflammation is not of primary importance in the initiation/promotion of cancer in this disease.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.4M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Butt JH, Lennard-Jones JE. A practical approach to the risk of cancer in inflammatory bowel disease. Med Clin North Am. 1980 Nov;64(6):1203–1220. [PubMed]
  • De Dombal FT, Watts JM, Watkinson G, Goligher JC. Local complications of ulcerative colitis: stricture, pseudopolyposis, and carcinoma of colon and rectum. Br Med J. 1966 Jun 11;1(5501):1442–1447. [PMC free article] [PubMed]
  • Elleder M. Eccrine gland involvement in Krabbe's disease. Virchows Arch A Pathol Anat Histopathol. 1992;421(4):351–354. [PMC free article] [PubMed]
  • Greenstein AJ, Sachar DB, Smith H, Janowitz HD, Aufses AH., Jr A comparison of cancer risk in Crohn's disease and ulcerative colitis. Cancer. 1981 Dec 15;48(12):2742–2745. [PubMed]
  • Lennard-Jones JE, Morson BC, Ritchie JK, Williams CB. Cancer surveillance in ulcerative colitis. Experience over 15 years. Lancet. 1983 Jul 16;2(8342):149–152. [PubMed]
  • Prior P, Gyde SN, Macartney JC, Thompson H, Waterhouse JA, Allan RN. Cancer morbidity in ulcerative colitis. Gut. 1982 Jun;23(6):490–497. [PMC free article] [PubMed]
  • Katzka I, Brody RS, Morris E, Katz S. Assessment of colorectal cancer risk in patients with ulcerative colitis: experience from a private practice. Gastroenterology. 1983 Jul;85(1):22–29. [PubMed]
  • Bonnevie O, Riis P, Anthonisen P. An epidemiological study of ulcerative colitis in Copenhagen County. Scand J Gastroenterol. 1968;3(4):432–438. [PubMed]
  • Evans JG, Acheson ED. An epidemiological study of ulcerative colitis and regional enteritis in the Oxford area. Gut. 1965 Aug;6(4):311–324. [PMC free article] [PubMed]
  • Lindén G, Möller C. Ulcerative colitis in Finland. II. One-year incidence in all hospitals. Dis Colon Rectum. 1971 Jul-Aug;14(4):264–266. [PubMed]
  • WIGLEY RD, MACLAURIN BP. A study of ulcerative colitis in New Zealand, showing a low incidence in Maoris. Br Med J. 1962 Jul 28;2(5299):228–231. [PMC free article] [PubMed]
  • Sinclair TS, Brunt PW, Mowat NA. Nonspecific proctocolitis in northeastern Scotland: a community study. Gastroenterology. 1983 Jul;85(1):1–11. [PubMed]
  • NEFZGER MD, ACHESON ED. Ulcerative colitis in the United States Army in 1944. Follow-up with particular reference to mortality in cases and controls. Gut. 1963 Jun;4:183–192. [PMC free article] [PubMed]
  • Watts JM, De Dombal FT, Watkinson G, Goligher JC. Long-term prognosis of ulcerative colitis. Br Med J. 1966 Jun 11;1(5501):1447–1453. [PMC free article] [PubMed]
  • Jalan KN, Prescott RJ, Sircus W, Card WI, McManus JP, Falconer CW, Small WP, Smith AN, Bruce J. An experience of ulcerative colitis. 3. Long term outcome. Gastroenterology. 1970 Oct;59(4):598–609. [PubMed]
  • Bonnevie O, Binder V, Anthonisen P, Riis P. The prognosis of ulcerative colitis. Scand J Gastroenterol. 1974;9(1):81–91. [PubMed]
  • Gilat T, Ribak J, Benaroya Y, Zemishlany Z, Weissman I. Ulcerative colitis in the Jewish population of Tel-Aviv Jafo. I. Epidemiology. Gastroenterology. 1974 Mar;66(3):335–342. [PubMed]
  • Storgaard L, Bischoff N, Henriksen FW, Fischerman K, Jarnum S. Survival rate in Crohn's disease and ulcerative colitis. Scand J Gastroenterol. 1979;14(2):225–230. [PubMed]
  • Hendriksen C, Kreiner S, Binder V. Long term prognosis in ulcerative colitis--based on results from a regional patient group from the county of Copenhagen. Gut. 1985 Feb;26(2):158–163. [PMC free article] [PubMed]
  • Kewenter J, Ahlman H, Hultén L. Cancer risk in extensive ulcerative colitis. Ann Surg. 1978 Dec;188(6):824–828. [PubMed]
  • Ritchie JK. Ileostomy and excisional surgery for chronic inflammatory disease of the colon: a survey of one hospital region. Gut. 1971 Jul;12(7):528–540. [PMC free article] [PubMed]
  • Peto R, Pike MC, Armitage P, Breslow NE, Cox DR, Howard SV, Mantel N, McPherson K, Peto J, Smith PG. Design and analysis of randomized clinical trials requiring prolonged observation of each patient. II. analysis and examples. Br J Cancer. 1977 Jan;35(1):1–39. [PubMed]
  • Devroede GJ, Taylor WF, Sauer WG, Jackman RJ, Stickler GB. Cancer risk and life expectancy of children with ulcerative colitis. N Engl J Med. 1971 Jul 1;285(1):17–21. [PubMed]

Articles from Gut are provided here courtesy of BMJ Publishing Group