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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Ulcerative colitis and colorectal cancer: Pathogenic insights and precision strategies for prevention and treatment
Martina Catalano, Enrico Mini, Stefania Nobili, Ismaela Anna Vascotto, Delia Ravizza, Andrea Amorosi, Francesco Tonelli, Franco Roviello, Giandomenico Roviello, Gabriella Nesi
Martina Catalano, Enrico Mini, Giandomenico Roviello, Gabriella Nesi, Department of Health Sciences, University of Florence, Florence 50134, Tuscany, Italy
Stefania Nobili, Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence 50134, Tuscany, Italy
Ismaela Anna Vascotto, Delia Ravizza, Department of Clinical Oncology, Careggi University Hospital, Florence 50139, Tuscany, Italy
Andrea Amorosi, Department of Health Sciences, “Magna Graecia” University of Catanzaro, Catanzaro 88100, Calabria, Italy
Francesco Tonelli, University of Florence, Florence 50134, Tuscany, Italy
Franco Roviello, Department of Surgical Oncology, University of Siena, Siena 53100, Tuscany, Italy
Author contributions: Roviello G contributed to the conceptualization, methodology, and software; Catalano M and Ravizza D contributed to the data curation and writing - original draft preparation; Nobili S and Nesi G contributed to the visualization and investigation; Mini E and Tonelli F contributed to the supervision; Catalano M, Vascotto IA, and Amorosi A contributed to the writing - reviewing and editing; Catalano M, Mini E, Nobili S, Vascotto IA, Ravizza D, Amorosi A, Tonelli F, Roviello F, Roviello G, and Nesi G contributed to drafting, substantial revision, and critical review of the manuscript. All authors approved the final version of the manuscript.
Conflict-of-interest statement: The authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Giandomenico Roviello, MD, PhD, Associate Professor, Department of Health Sciences, University of Florence, viale Pieraccini, 6, Florence 50134, Tuscany, Italy.
giandomenico.roviello@unifi.it
Received: April 16, 2025
Revised: May 28, 2025
Accepted: August 15, 2025
Published online: October 15, 2025
Processing time: 181 Days and 16.5 Hours
Ulcerative colitis (UC) is associated with an increased risk of developing colitis-associated colorectal cancer (caCRC), a major complication of long-standing disease. In this review, we examined the pathogenic association between UC and caCRC, highlighting the risk factors, molecular mechanisms, and current strategies for prevention and management. Compared to sporadic colorectal cancer, caCRC tends to occur at a younger age and is more frequently characterized by mucinous or signet-ring cell histology, proximal colonic involvement, and a higher incidence of synchronous lesions. The risk of caCRC increases 8-10 years after UC diagnosis and is influenced by disease duration, extent of colonic involvement, inflammatory burden, family history of colorectal cancer, and coexisting primary sclerosing cholangitis. The inflammation-to-cancer progression follows a multistep pathway of genetic alterations, advancing from low-grade to high-grade dysplasia, and ultimately to carcinoma. While chemopreventive agents such as 5-aminosalicylates may offer some benefit, surveillance colonoscopy remains the primary strategy for risk reduction. Early detection and individualized prevention strategies are critical for improving long-term outcomes in patients with UC.
Core Tip: Ulcerative colitis is a chronic inflammatory bowel disease with increased risk of colorectal cancer (CRC), particularly colitis-associated CRC (caCRC). The development of caCRC is influenced by disease duration, extent, severity, and factors such as primary sclerosing cholangitis and family history. Unlike sporadic CRC, caCRC tends to occur at a younger age and follows a distinct inflammation-dysplasia-carcinoma sequence. This review highlights the pathogenic link between ulcerative colitis and CRC and summarizes current strategies for prevention, surveillance, and management to improve patient outcomes.
