Advancing Inflammatory Bowel Disease-Driven Colorectal Cancer Management: Molecular Insights and Endoscopic Breakthroughs Towards Precision Medicine

Colorectal cancer (CRC) is a serious complication of inflammatory bowel disease (IBD), significantly contributing to increased mortality and health care burden. Although advances in IBD management have led to a decline in CRC incidence, it remains a major clinical concern. Recent breakthroughs in advanced imaging, molecular diagnostics, and artificial intelligence are poised to revolutionize precision medicine in IBD-associated CRC, potentially reducing neoplastic risk and improving patient outcomes. This review explores emerging concepts in colitis-associated cancer pathogenesis, including the intricate interplay between diet, microbiome alterations, and intestinal barrier dysfunction in CRC progression. Additionally, it highlights cutting-edge diagnostic and assessment techniques, such as ultra-high magnification endoscopy, and new spatial biology platforms for assessing intestinal barrier integrity and molecular biomarkers, such as microRNAs and liquid biopsy. The future of IBD-related CRC management will incorporate a holistic, multi-integrated approach, combining artificial intelligence–driven diagnostics, omics data integration, endoscopic and surgical innovations, and nanotechnology-based therapies. This paradigm shift aims to enhance precision medicine, promoting organ-sparing approaches, improved diagnostics, and personalized cancer treatment with the potential to reduce CRC risk.