I have UC. Does uncontrolled inflammation raise cancer risk?

Question

Hello doctor,

I am 35 years old and was diagnosed with ulcerative colitis two years ago. I am on Mesalamine 4.8 g daily, but my recent colonoscopy still showed active inflammation in the rectum and sigmoid colon.

My fecal calprotectin came back 420, and I still get four to five loose stools daily with occasional blood. So, I have a few concerns -

Should I discuss stepping up to biologics like Infliximab now, or increase the Mesalamine dose first?
Also, is there a risk of colon cancer if inflammation stays uncontrolled for a long time?
How often should I repeat a colonoscopy for monitoring, and are probiotics actually effective in maintaining remission or mostly just supportive in UC cases?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Since you are already on a full dose of Mesalamine at 4.8 g daily and still have active disease with elevated fecal calprotectin and persistent symptoms, it would be reasonable to discuss stepping up therapy rather than only increasing Mesalamine, as further benefit from dose escalation alone is unlikely.

In patients with moderate ulcerative colitis not controlled on Mesalamine, biologics such as Infliximab, adalimumab, Vedolizumab, or Ustekinumab, or small molecule options like Tofacitinib in certain settings, are often considered next line to achieve mucosal healing and prevent long-term complications.

Uncontrolled inflammation over the years does increase the risk of colorectal cancer, especially if the disease has been present for more than eight to ten years, so achieving and maintaining remission is critical.

Colonoscopy surveillance is usually recommended every one to three years once you reach eight years of disease duration, but the timing can be shorter if inflammation remains active.

As for probiotics, evidence suggests they may help some patients in maintaining remission, particularly with mild disease, but they are not a substitute for standard therapy and should be viewed as supportive rather than primary treatment.

It is important to discuss these options with your gastroenterologist now, since your disease activity suggests that stronger therapy may be needed to protect your colon long-term.

I hope this helps you.

Please feel free to reach out to me at any time. I am always here to help.

Take care.

Regards.