In this episode, Pradeep Mundre speaks with Hannah Gordon about one of the most challenging areas in inflammatory bowel disease management: balancing effective treatment with cancer risk. As therapeutic options expand, clinicians increasingly face complex scenarios involving patients with prior malignancy in remission or those undergoing active cancer treatment. The discussion examines how cancer risk relates both to IBD itself and to immunosuppressive or biologic therapies. The episode highlights limitations in current evidence, differences across drug classes, and the importance of individualised decision-making. Emphasis is placed on multidisciplinary collaboration, patient communication, and navigating uncertainty in real-world clinical practice.