Case 8.7

This patient is successfully vaccinated to influenza, herpes zoster, and pneumococcal pneumonia.  The patient enjoys clinical remission for 5 years, however then presents to his biannual clinic visit with 6 weeks of increased stool frequency, rectal bleeding, and weight loss of 5 lbs.  You rule out infectious colitis, and perform a colonoscopy.  There is evidence of Mayo 2 disease in the rectum, sigmoid colon, and descending colon.  Additionally, there is a 5 cm, flat dysplastic appearing lesion with poorly demarcated borders in the transverse colon and another 2.5 cm flat dysplastic lesion with poorly demarcated borders in the sigmoid colon.  Biopsies of these areas demonstrate high grade dysplasia, which is confirmed by a pathologist with expertise in IBD pathology.  After a discussion with the patient about next steps, the patient decides he would like to proceed to colectomy. 

Which of the following is true about colorectal cancer and surgery in senior age IBD patients? Pick all that apply:
Older adult onset IBD is associated with increased risk of developing colorectal cancer.
Older age at diagnosis of IBD is not associated with an increased risk of colorectal cancer compared to younger adults diagnosed with IBD
Patients diagnosed with IBD at an older age may have a shorter interval between IBD diagnosis and diagnosis of colorectal cancer compared to younger patients with IBD.
Patients with ulcerative colitis undergoing ileo-pouch anal anastomosis (IPAA) who are over the age of 60 years are more likely to have a longer length of stay after surgery.
Age is associated with increased odds of getting an end ileostomy.
Independent risk factors for pouch dysfunction after IPAA surgery include age, obesity, sex, history of pelvic radiation, history of sphincter damage or dysfunction.

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