The looong story:

I was diagnosed with ulcerative colitis (pancolitis) in Dec 2008. Although I took prednisone when I had flares, until 2020 I used only mesalamine the rest of the time, refusing the advice that I should try a TNF blocker like Humira and/or azathioprine.

I had developed severe inflammation in my colon, so they generally did not remove small polyps. However in 2016 they removed a small area and marked for observation. In 2019 a dr tried to remove a much larger area during a colonoscopy rather than waiting for pathology because he thought it was suspicious. Turns out it was just inflammation, and his botched job caused so much bleeding that I had to stay in the hospital overnight.

Up to this point I continued to have severe UC with severe inflammation but nothing was precancerous.

However, I knew the chance of cancer was increasing, and if anything, UC was getting worse. So in 1/20 I agreed to start Humira and azathioprine (Imuran). It didn't do any good and when they dropped the mesalamine I started a major flare.

I also developed neuropathy in my feet and lower legs (attributed to Humira) after a few weeks, and in 4/20 I had a cerebral stroke (some drs said Humira and others inflammation was the cause). I stopped Humira then.

A few months later they tried Entyvio. Major flare continued and no improvement despite increasing from every 2 months to once a month.

After a while they switched to Stelara. Only a very minor improvement even after going to once a month.

Early on they considered Xeljanz, but it was too soon after the stroke. Around the time of Stelara my dr mentioned Zeposia, but felt there were better alternatives.

After antibiotics for hip surgery triggered a BIG c-diff flare in 2022, my GI dr at the time did a colonoscopy in 8/22. She found severe UC/inflammation so decided it was time to try something else. She also found an area with mild dysplasia.

She briefly considered Syrizi, (which was approved for Crohn's but off label for UC at the time), but decided on Rinvoq.

If I had stayed, she would have given Rinvoq a couple of months to reduce inflammation and then gone back in to remove the dysplasia around Nov 2022.

However, I returned home and my home GI dr waited until Jan 2023 to do another colonoscopy. That colonoscopy found significant improvement in the UC with sufficient mucosal healing that it was classified as mild UC/mild inflammation. But the area identified in 8/23 was now categorized as high dysplasia (precancerous).

After consultation with my GI dr, a complex polyps specialist, and a colorectal surgeon, we agreed to try an endoscopic mucosal resection (EMR) to remove the precancerous area.

The EMR was successful, but the pathology showed a small area where it had started to convert to cancer. Although they thought they probably got it all and I had an option to wait and just do increased monitoring, I called it quits and elected a total proctocolectomy with end ileostomy.

Given the cancer issue they took the fat surrounding the colon along with everything else so they could test over 70 lymph nodes. I am happy to say they found nothing and saw no need for radiation or chemotherapy.

At several points it was suggested I consider a colectomy as an option, and I even consulted with the colorectal surgeon in 2021 after Entyvio failed, but I adamantly refused and kept trying to find a successful treatment .However, I have no regrets about my final decision.

Long story short: In Rinvoq I finally found something that worked for my UC. But I guess my colon was too damaged by then and it did nothing to arrest the development of cancer.

I hope you can find your solution, and I do recommend asking about Rinvoq.