If you have ulcerative colitis (UC), you’re probably aware that inflammation causes many of its symptoms. But what’s less commonly known is that it’s also a likely culprit behind an increased risk of colorectal cancer.
People with inflammatory bowel disease, including UC, are about twice as likely to develop colorectal cancer, compared with those without the disease.
This risk builds over time, increasing by 2 percent after 10 years of having a diagnosis, 8 percent after 20 years, and 30 percent after 30 years. How long you’ve had UC and how severe it is may both affect your colorectal cancer risk.
Why Ulcerative Colitis Is Linked to an Increased Colorectal Cancer Risk
When you have UC, your immune system mistakenly attacks the lining of your colon (large intestine), causing damage. As your body works overtime to try to repair the damage, cell changes can occur, increasing your risk of cancer in the colon or rectum.
“The greater the inflammatory burden, and perhaps the longer that a person with UC has ongoing inflammation, the greater the risk of developing colorectal cancer,” says Edward L. Barnes, MD, a gastroenterologist and an assistant professor of medicine at the University of North Carolina in Chapel Hill.
What’s more, if you’re among the subset of people with UC who also develop primary sclerosing cholangitis — a rare condition that causes scarring in the bile ducts of the liver — your risk of colorectal cancer may be significantly higher.
In one study, just under 4 percent of people with UC developed primary sclerosing cholangitis. People who developed the condition were nearly three times more likely to develop colorectal cancer and more than 36 times more likely to develop biliary tract or bile duct cancer (also called cholangiocarcinoma) than the general population.
What to Do to Prevent and Detect Colorectal Cancer
You can take steps to reduce your risk of colorectal cancer.
1. Find a UC Treatment That Works
Newer medications for UC are enabling some people to achieve remission, Dr. Barnes says. If your current treatment regimen isn’t controlling your symptoms, talk to your doctor about exploring new options, he advises, both for “better symptom control and improved quality of life.”
“We believe that treating inflammation in UC is very important,” Barnes says. One reason: Research shows greater inflammation may increase your risk of the genetic mutation that causes colon cancer, but treatment can help tamp down inflammation.
If your UC doesn’t respond to medication, surgery is also an option. A procedure called a proctocolectomy involves removing your entire colon and rectum to eliminate UC.
In most cases, the surgeon will perform an ileoanal anastomosis (J-pouch) surgery, in which they construct a pouch from the end of your small intestine and attach it directly to your anus. This method allows you to use the bathroom in a relatively usual way without a colostomy bag.
2. Once You Find an Effective UC Treatment, Stick With It
The goal of treatment is to reduce inflammation in the colon and rectum, which can be a breeding ground for cancer cells.
Taking your medications as directed reduces your risk of flares and complications. Consistently taking your medication is the best way to avoid cumulative inflammation, or inflammation that builds up, damaging colonic and rectal health, Barnes says. This applies even when you’re not experiencing active flares and feel healthy.
“The major way that we try to reduce the risk of colorectal cancer in patients with UC is better control of inflammation,” he says. “We hope that better control of UC will reduce their risk of developing colorectal cancer.”
3. Eat a Nutritious Diet and Avoid Trigger Foods
A balanced diet can help you maintain your overall health and make it easier to manage your UC inflammation and symptoms.
You should also steer clear of any foods that seem to trigger your symptoms. Triggers often vary from person to person, but in general, it helps to avoid foods that are high in fat or refined and added sugars, as well as:
High-lactose dairy products
Caffeine
Alcohol
Raw fruits and vegetables, which are harder on the gut than cooked, chopped, or pureed fruits and veggies
Spicy foods
If you’re having trouble pinpointing your trigger foods, consider working with a registered dietitian. They can also help you identify foods and meals that are gentle on your gut and prevent nutritional deficiencies if you need to avoid certain foods.
4. Exercise Regularly
Exercise can help manage many of the complications of UC, including reduced bone density, the mental health effects of living with UC, and a weakened immune system, which can hinder your body’s ability to stave off inflammation.
If you have UC, try low-impact, moderately intense exercise regularly, as long as your doctor approves. No single activity is better than others. Find activities you enjoy that get your heart racing, stay hydrated with lots of water, and switch up your workouts to avoid getting bored.
5. Get Screened for Cancer
Colorectal cancer can develop earlier in people who have inflammatory bowel disease (IBD) than in people without it, says Amosy Ephreim M’Koma, MD, a colon and rectal surgeon at Vanderbilt-Ingram Cancer Center in Nashville.
Essentially, that’s because the cumulative inflammation in the colon seen with UC likely speeds up the development of the genetic mutations that cause cancer, Dr. Ephreim M’Koma says.
If you have UC, you should get a colonoscopy beginning at least eight years after you were diagnosed with IBD. You may need a follow-up colonoscopy every one to three years, depending on your risk factors and the results of the test.
If you have both UC and primary sclerosing cholangitis, you should get a colonoscopy as soon as possible and then again every one to two years after that.
This is called “surveillance colonoscopy,” and your doctor will be “looking for any early signs of dysplasia or precancerous changes,” Barnes says. “The presence of dysplasia will often trigger changes in how we manage the patient’s condition. Making sure that the patient is getting colonoscopies to try and identify these changes early, before they develop colorectal cancer, is a key point of managing the risk.”
The Takeaway
Inflammation caused by ulcerative colitis can lead to cell changes in the rectum and colon that increase the risk of colorectal cancer.
Managing UC with medications, getting cancer screenings every one to three years after diagnosis, avoiding trigger foods, eating a balanced diet, and getting regular exercise can all contribute to less inflammation and a lower colorectal cancer risk.
Work closely with your doctor to manage your UC and your cancer risk as much as possible.
Ira Daniel Breite, MD, is a board-certified internist and gastroenterologist. He is an associate professor at the Icahn School of Medicine at Mount Sinai, where he also sees patients and helps run an ambulatory surgery center.
Dr. Breite divides his time between technical procedures, reading about new topics, and helping patients with some of their most intimate problems. He finds the deepest fulfillment in the long-term relationships he develops and is thrilled when a patient with irritable bowel syndrome or inflammatory bowel disease improves on the regimen he worked with them to create.
Breite went to Albert Einstein College of Medicine for medical school, followed by a residency at NYU and Bellevue Hospital and a gastroenterology fellowship at Memorial Sloan Kettering Cancer Center. Working in city hospitals helped him become resourceful and taught him how to interact with people from different backgrounds.
Brian P. Dunleavy is a writer and editor with more than 25 years of experience covering issues related to health and medicine for both consumer and professional audiences. As a journalist, his work has focused on new research in the treatment of infectious diseases, neurological disorders (including multiple sclerosis and Alzheimer's disease), and pain management. His work has appeared in ADDitude, Consumer Reports, Health, Pain Medicine News, and Clinical Oncology News.
Dunleavy is the former editor of the infectious disease special edition at ContagionLive.com. He is also an experienced sports reporter who has covered the NFL, MLB, NBA, NHL, and professional soccer for a number of publications. He is based in New York City.
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
Greuter T et al. Malignancies in Inflammatory Bowel Disease. Digestion. August 14, 2020.
Lynch WD et al. Ulcerative Colitis. StatPearls. June 5, 2023.
Short SP et al. Colonic Epithelial-Derived Selenoprotein P Is the Source for Antioxidant-Mediated Protection in Colitis-Associated Cancer. Gastroenterology. April 2021.
Ulcerative Colitis. Mayo Clinic. November 22, 2024.
