• Lymphoma of the small bowel is rare in the UK, even in people with untreated coeliac disease.
• Research shows that the higher risk of developing these types of cancer in people with coeliac disease is much less than previously thought.
• Following a gluten free diet reduces the already low risk of developing these types of cancer.

Cancer is a very rare complication of untreated coeliac disease.

Compared with the general population, people with coeliac disease have an increased risk of developing the following cancers:

• cancer of the small bowel, often referred to as adenocarcioma of the small bowel
• a very rare type of non-Hodgkin’s lymphoma of the small bowel called enteropathy associated T cell lymphoma (EATL)
• other types of non-Hodgkin’s lymphoma
• Hodgkin’s lymphoma.

However, the majority of people with coeliac disease do not develop lymphoma or the other cancers that are associated with coeliac disease.

Recent research shows that the higher risk in people with coeliac disease of developing these particular types of cancer is much less than previously thought.

Following a gluten free diet allows your gut to heal and reduces the already low risk of developing these specific types of cancer. Research suggests that the risk of developing these specific types of cancer decreases with time from diagnosis of coeliac disease to nearly the same as occurs in the general population.

Lymphoma

Lymphoma is a type of cancer that affects the lymphatic system. The lymphatic system is made up of the lymph glands, lymphatic vessels and the spleen. The lymphatic system helps your body fight infection and filters body fluid.

Lymphoma of the small bowel is rare in the UK – even in people with untreated coeliac disease.

Non-Hodgkin’s lymphoma

Non-Hodgkin’s lymphoma can affect any part of the body including the small bowel, stomach and bones.

Enteropathy associated T cell lymphoma

Enteropathy associated T cell lymphoma (EATL) is a very rare type of non-Hodgkin’s lymphoma affecting around one in a million people in the general population. It makes up less than 1% of all non-Hodgkin’s lymphomas.

The main symptoms linked with EATL are gut problems such as persistent diarrhoea, stomach pain and unexplained weight loss.

People with coeliac disease have a slightly higher risk of developing EATL because it affects the same part of the gut that is affected in coeliac disease. However, even with this slightly increased risk, overall the likelihood of developing this type of cancer is still very rare.

Evidence suggesting that people with dermatitis herpetiformis also have an increased risk of cancer, particularly lymphoma, is conflicting with some studies showing that there is no increased risk.

You are at an increased risk of developing EATL if you have been diagnosed with refractory coeliac disease.

Small bowel cancer

We do not know the cause of small bowel cancers. One of the mechanisms that could be involved is the increased turnover of various types of cells in the bowel wall, where there is active inflammation and the villi of the gut lining are trying to regenerate.

Following a strict gluten free diet will help reduce your already low risk of developing cancer.

Other cancers

There appears to be a lower risk of developing breast cancer and lung cancer when you have coeliac disease. Although further research is needed to understand the reasons for this, the lower association with lung cancer could be because people with coeliac disease may be less likely to smoke.