After many years of ulcerative colitis, which cancer risk increases and what surveillance is recommended?

• A. Esophageal cancer risk increases; endoscopy every 5 years with biopsy
• B. Pancreatic cancer risk increases; MRI annually
• C. Stomach cancer risk increases; yearly gastroscopy
• D. Colorectal cancer risk increases; annual or biennial colonoscopy surveillance with biopsies

Answer: (D)

Longstanding ulcerative colitis raises the risk of colorectal cancer because chronic inflammation can lead to dysplasia in the colonic lining. This risk becomes meaningful after many years of disease, especially with extensive involvement. The appropriate surveillance is colonoscopy with biopsies to detect dysplasia early, typically starting 8–10 years after disease onset and repeated every 1–2 years. More frequent surveillance is advised if additional risk factors are present, such as primary sclerosing cholangitis or a history of dysplasia. The other options don’t fit because they focus on cancers not primarily linked to ulcerative colitis and use surveillance intervals that aren’t standard for this condition.