Patients with ulcerative colitis (UC) are at increased risk of developing colorectal cancer. Independent risk factors include age, gender, extent and duration of disease activity, concurrent primary sclerosing cholangitis, a family history of sporadic colorectal cancer and severity of histologic bowel inflammation. Surveillance programs have been introduced to facilitate early detection of pre-malignant lesions, however, the efficacy of these programs have not been established. Technological endoscopic advancements and improved treatment options may also reduce the incidence of colorectal cancer in this population.