Inflammatory bowel disease-associated colorectal cancer: translational risks from mechanisms to medicines

The cumulative impact of chronic inflammation in patients with inflammatory bowel diseases predisposes to the development of inflammatory bowel disease-associated colorectal cancer (IBD-CRC). Inflammation can induce mutagenesis and the relapsing-remitting nature of this inflammation, together with epithelial regeneration, may exert selective pressure accelerating carcinogenesis. The molecular pathogenesis of IBD-CRC, termed the ‘inflammation-dysplasia-carcinoma’ sequence, is well described. However, the immunopathogenesis of IBD-CRC is less well understood. The impact of novel immunosuppressive therapies, which aim to achieve deep remission, is mostly unknown. Therefore, this timely review summarises the clinical context of IBD-CRC, outlines the molecular and immunological basis of disease pathogenesis and considers the impact of novel biologic therapies.