Exploring the Cancer Risk Associated with Serrated Lesions in IBD (V1)
Research type
Research Study
Full title
Exploring the Clinical and Molecular Significance of Colonic Serrated Lesions in Patients with Inflammatory Bowel Disease to Better Understand the Risk of Neoplasia
IRAS ID
335652
Contact name
Ana Wilson
Contact email
Sponsor organisation
London Northwest University Hospitals NHS Trust
Duration of Study in the UK
5 years, 0 months, 0 days
Research summary
Inflammatory bowel disease (IBD), characterised by chronic inflammation of the bowel, increases the risk of colon (large bowel) cancer and those with associated primary sclerosing cholangitis display an even greater risk. Despite regular surveillance with colonoscopy, that aims to detect and remove precursor lesions (growths that have cancer potential), colon cancer is still responsible for a significant proportion of deaths in IBD.
Sessile serrated lesions (SSLs), serrated (saw-like shaped) precursor lesions of the colon are typically more difficult to detect on colonoscopy and progress more quickly to cancer than the more traditional adenoma, that was originally thought to be the only culprit to develop into colon cancer. We hypothesize that SSLs play a significant role in IBD-cancer and are influenced by the level of inflammation. We aim to characterise SSLs in IBD by assessing their clinical and genetic backgrounds in comparison to those found in patients without IBD.
A further serrated lesion, distinct from SSLs, has been identified in patients with long-standing IBD, termed serrated epithelial change (SEC). Although SEC does not appear to show features of dysplasia (pre-cancerous changes) histologically (under the microscope), initial molecular work suggests that it harbours distinct genetic changes that are not seen in normal tissue. We propose that SEC is a morphological representation of a colonic "cancer field", apparently normal colonic tissue that already harbours genetic mutations that predispose to cancer progression. Currently, clinicians are unable to personalise management for patients with SEC due to lack of information of its significance. Through clinical and molecular investigation, our work aims to elucidate the risk of cancer associated with SEC.
Our work will provide a critical understanding of the cancer risk associated with serrated lesions in IBD. This will enable the creation of recommendations to aid personalised decision-making in monitoring IBD patients with serrated findings.
REC name
West Midlands - Solihull Research Ethics Committee
REC reference
24/WM/0047
Date of REC Opinion
17 May 2024
REC opinion
Further Information Favourable Opinion