What is the impact of long-standing ulcerative colitis on cancer surveillance strategies?

• A. It does not affect cancer risk.
• B. Surveillance is needed only if symptoms are present.
• C. It increases colorectal cancer risk and requires lifelong colonoscopy surveillance beginning after 8–10 years.
• D. Surveillance is needed annually starting at diagnosis.

Answer: (C)

Chronic inflammation from long-standing ulcerative colitis raises the risk of colorectal cancer over time, so the goal is to monitor the colon proactively to catch dysplasia early. Because the risk grows with how long and how extensively the colon is inflamed, surveillance is lifelong and starts after about 8–10 years of disease. Regular colonoscopy, with biopsies as needed, allows for early detection of dysplastic changes before cancer develops. This approach is needed even if the patient has no symptoms, since cancer can develop quietly during periods of quiescent disease. Starting surveillance at diagnosis or only when symptoms appear would miss early cancers, whereas lifelong colonoscopy beginning after 8–10 years aligns with established practice.