Ten years after diagnosis of total proctocolitis this patient undergoes colonoscopy and biopsy reveals high-grade dysplasia in 2-10 specimens. What should the physician recommend?

Risk of dysplasia and colorectal cancer is higher in ulcerative colitis than in the general population. The severity, duration, and anatomic extent of the inflammation are risk factors for the development of dysplasia and cancer. These cancers do not seem to follow the adenoma carcinoma sequence and can arise in flat mucosa making them difficult to detect even with regular colonoscopies. After 8-10 years of colitis surveillance colonoscopy should be performed with multiple random biopsies. The finding of dysplasia is an indication for immediate total proctocolectomy. Centers have reported up to 42% of colons removed for dysplasia also had colon cancer.