Genomic instability in ulcerative colitis: a prerequisite for cancer in the inflammatory colon ?

Ulcerative colitis (UC), a chronic and relapsing idiopathic inflammatory disease of the colon, although not associated with an increased mortality compared to the general population, has a sub- stantial morbidity leading to sizable health care costs, as it carries an increased risk for development of colorectal cancer (CRC). The pathophysiology behind this carcinogenic pathway is multifactori- al. This review summarizes the major pathogenetic steps from which the inflamed colonic epithelium is transformed to a dysplas- tic and/or cancerous one. The role of the inflammatory and immune system, the oxidative stress generated as well as the genomic stability observed in UC-associated CRC is presented so as to provide a more spherical view of the tumorigenic process and, if possible, offer new diagnostic approaches for the early detection of CRC. (Acta gastroenterol. belg., 2012, 75, 293-299).