How Ulcerative Colitis Affects Your Risk for Developing Colorectal Cancer

Categories: Colorectal Cancer, Gastrointestinal Cancers

February 28, 2022

Did you know there’s a significant link between ulcerative colitis (UC) and colorectal cancer? Ulcerative colitis patients have a six times greater risk of developing colorectal cancer than those of average risk. But, that being said, only about 5% of people with severe ulcerative colitis will end up developing this type of cancer. Plus, there are ways you can lower your risk.

What is Ulcerative Colitis?

Ulcerative colitis is one type of irritable bowel disease (IBD). It can cause pain, inflammation (swelling), and ulcers (sores) in the inner lining of your intestine and rectum. 

The cause of ulcerative colitis is unknown, and most cases are diagnosed before age 30, although it can happen at older ages. A high-fat diet and stress can worsen symptoms, but they do not cause UC. Some researchers believe ulcerative colitis may be caused by a malfunctioning immune system that attacks your colon, which causes inflammation. 

Heredity plays a role for a few people. Ulcerative colitis is more common in people with a family history of ulcerative colitis or other IBDs. However, most cases have no family history of the disease. 

Your ulcerative colitis risk is higher if you frequently use NSAID medications, like aspirin, ibuprofen, or naproxen.

In addition to increasing your risk for colon or rectal cancer, ulcerative colitis inflammation can cause arthritis, eye inflammation, liver disease, and osteoporosis. 

There's no cure for UC, but medications and lifestyle changes can calm the inflammation and help you get to long-term remission. Good control of flare-ups and other ulcerative colitis symptoms help reduce your risk of developing colorectal cancer.

Understanding Colorectal Cancer 

Colorectal cancer develops in the colon (digestive tract), rectum, or both. Colon cancer usually starts in a polyp – a small, non-cancerous group of cells that can turn into a cancerous polyp attached to the lining of the colon.

Colorectal cancer risk factors increase if you:

  • Smoke tobacco
  • Are over age 50
  • Are a heavy alcohol drinker
  • Are African-American  
  • Have chronic inflammatory conditions such as ulcerative colitis or Crohn's disease
  • Have a family history of cancer
  • Have a history of polyps
  • Eat a low-fiber diet, high in fat and calories
  • Don't get regular physical activity
  • Have diabetes
  • Are overweight

There aren’t many symptoms of colon cancer which means screening is the best way to find it early. If you’re at a higher risk – especially if you’ve had an ulcerative colitis diagnosis for a while – you should talk to your primary care doctor about starting cancer screening sooner than the average age. 

If cancer is suspected, diagnosis can be more difficult to make if the patient has ulcerative colitis. That’s because some of the symptoms are the same for both conditions. For example, blood in the stool is a warning sign of both cancer and an ulcerative colitis flare-up.  

How Does Ulcerative Colitis Increase the Risk of Colorectal Cancer?

If you have ulcerative colitis, your risk of developing colon cancer is higher if you have the following conditions:

  • An ulcerative colitis diagnosis at a young age
  • Had ulcerative colitis for more than eight years
  • Ulcerative colitis that affects most of your colon
  • Uncontrolled (chronic) inflammation
  • Immune system weakening conditions such as diabetes 
  • Precancerous cell damage
  • Had your appendix removed
  • Damage to your liver's bile duct from inflammation or scarring
  • Family history of ulcerative colitis

Chronic Inflammation in the Colon from Ulcerative Colitis

UC causes chronic inflammation that affects the cells lining the large intestine (colon). Chronic inflammation, like that caused by ulcerative colitis, is an ongoing issue. And when left untreated it can lead to the development of cancer in the colon or rectum. 

Chronic inflammation is known to:

  • Damage your colon lining and destroy cells that repair other cells. Without repairs, damage can occur to DNA (the genetic material in your cells) in your colon cells, contributing to ulcer development. 
  • Increase the level of molecules that promote cancerous tumor growth.
  • Make you more susceptible to infections, which help cancer cells grow and multiply. 

Why Regular Colorectal Cancer Screenings are So Important

Colorectal cancer is curable, especially in the early stages. The best chance of complete remission comes with finding polyps early that need to be removed before they turn into cancer. This makes the entire process easier on you, less invasive, reduces the chance of it spreading to other organs, and is less expensive than late-stage cancer treatment.

To find colorectal cancer early, you need to stick with a regular cancer screening schedule. If you have ulcerative colitis or other medical conditions that put you at risk for colorectal cancer, your primary care doctor may recommend starting cancer screenings younger than the average age of 45. Screening for colon and rectal cancer can be done with an at-home stool test using a test such as a colonoscopy or a sigmoidoscopy. The right test for you, based on the severity of the UC, will be determined by your physician. 

How Can I Reduce My Cancer Risks?

Healthy lifestyle choices are especially helpful in preventing both ulcerative colitis and colon cancer and help detect it early. Some of the most important choices you can make include:

  • Eat a healthy diet with less red meat and processed meats, sugar, fat, soft drinks, and other processed foods. Increase fish, chicken, and protein options like cheese, cottage cheese, nuts, and beans, as well as vegetables, fruits, and whole grains. Frying, broiling, or grilling meats at high temperatures increases cancer risk.  
  • Maintain a healthy weight.
  • Stay physically active – 30 minutes to an hour of activity on most days.
  • Stop smoking.
  • Limit or stop drinking alcohol. 
  • Try to drink 100 ounces of water per day to keep your body cleansed.
  • Have regular colorectal cancer screenings.

What to Do if You’re Diagnosed With Colorectal Cancer When You Have Ulcerative Colitis?

There are experts in cancer care called oncologists, like those at Compass Oncology, who will assess all of your health conditions to make a recommended colorectal treatment plan. Your treatments may be a bit different than someone who doesn’t have UC. Be sure to ask a lot of questions. There are no silly questions when it comes to your healthcare.

If you live in the Portland-Vancouver area and receive a colorectal cancer diagnosis, our team of GI cancer oncologists will guide you through the treatment process. Request an appointment for a consultation. Second opinions are available.

Find a Medical Oncologist