Ulcerative colitis and colon cancer: strategies for cancer prevention.

The risk of development of colon cancer in patients with ulcerative colitis is an emotive issue with patients and a potential medico-legal problem for physicians caring for such patients. The exact magnitude of the risk is not clearly defined. Current surveillance programmes use dysplasia as a marker for the risk of invasive carcinoma development, but this strategy has inherent limitations. A number of new molecular markers have been investigated but none are currently considered robust enough for routine clinical use. Recommendations for patient selection and interval for colonoscopic surveillance are currently pragmatic, and not entirely evidence-based. Nevertheless, optimal medical management and adherence to a surveillance programme geared to detect dysplasia might still be the best risk reduction strategy.