Determining when limited resection can safely prevent cancer in inflammatory bowel disease

Lead researcher: Dr Annie Baker

Location: Institute of Cancer Research, London

Grant award: £25,000

Dr Baker and her team looked for ways to predict which inflammatory bowel disease patients can safely have only part of their bowel removed when they show signs of precancerous changes and which patients should have their whole bowel removed to prevent further risk of bowel cancer. 

The challenge

People with inflammatory bowel disease (IBD), chronic inflammation of the bowel, have a higher risk of developing bowel cancer. They are closely monitored for signs of tissue with precancerous changes, and if these are found, they will either have their whole bowel removed (a colectomy) or only have the affected section of the bowel removed (a limited resection).

A colectomy is major and complex surgery, with significant health implications afterwards; a limited resection is less invasive but there is still the risk of developing further areas of irregular tissue or cancer in the parts of the bowel that are left, requiring further treatment.

The science behind the project

When the irregular area of tissue is removed, the surgeon will also take an area of healthy tissue around it (the margin). However, Dr Baker’s research group have shown that even when this tissue looks normal under the microscope, it can be carrying abnormal DNA mutations.

They looked at preserved tissue samples from patients who have had limited resections, to see what mutations they had in their precancerous growth and if any were also present in their margins. They then checked if the people who had mutations in their “normal” tissue were more likely to develop further precancer or cancer.

Results

The team looked at samples from 52 IBD patients who had precancerous tissue removed at St Marks Hospital in London. They found that there was a pattern between DNA mutations in “normal” margins, and increased risk of developing bowel cancer in the future.

What difference will this project make?

This project is a very encouraging step towards predicting which people with IBD can safely treat their precancerous changes by having limited resections to only remove part of their bowel and which people are at higher risk of further changes and so should have their whole bowel removed. 

Further studies are now required to confirm the results of this pilot project, before it can be taken into the clinic. 

In future, a test like this will support more informed decision making by patients and their clinicians about the best treatment option for them, including potential for the development of targeted screening methods for patients with IBD.

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