Association of celiac disease and intestinal lymphomas and other cancers
Section snippets
EATL
EATL is an intestinal T-cell lymphoma that can occur in adults, with a peak in the sixth decade of life. Not a single case of EATL was found in a series of CD-associated tumors in children,12 indicating that many years of latency need to occur between the onset of CD and the development of EATL. With an annual incidence rate of 0.5–1 per million people in Western countries, this is a rare form of cancer, covering approximately 35% of all small bowel lymphomas. By definition, this NHL subtype
Possible mechanisms of carcinogenesis
The mechanisms responsible for the development of malignancies in patients with CD are not known. The following explanations have been suggested: increased intestinal permeability of environmental carcinogens, chronic inflammation, chronic antigenic stimulation, release of proinflammatory cytokines, immune surveillance problems, and nutritional deficiencies caused by the disease or the GFD.31
Given the long latency between CD and cancer development, it seems logical to hypothesize that this is a
The magnitude of the NHL risk
From the public health perspective, the magnitude of NHL risk associated with CD is important, but this was far from clear until recently. Previous studies indicated a strongly increased relative risk (RR), in the range of 40 to 100, emphasizing the high prevalence of this association in adults with CD.7, 10 Such a “pessimistic” point of view was apparently confirmed by mortality analysis in CD patients showing an 11.4- to 69-fold increased risk of dying from lymphoma.5, 34, 35
In recent years,
Does the GFD protect against cancer development?
Conflicting data on the protective effect of treatment with the GFD on the development of malignancy have recently been reviewed.39 It is evident that cancer may arise in subjects who have been treated with the GFD, sometimes for years.31 This finding apparently denies any beneficial effect of dietary treatment of CD on cancer risk. However, many of these cases had previously been exposed to dietary gluten for a long time, usually for some decades, whereas the period on GFD was brief.31 Thus,
Conclusions
CD is associated with a definite increase in the risk of developing cancer, especially EATL and other gastrointestinal cancers that are partially responsible for the overall increased mortality reported in CD patients. However, the magnitude of the overall risk of NHL is much lower than previously thought, with a relative risk most probably ranging between 2 and 4. There is compelling evidence to suggest that the GFD protects against the development of CD-associated malignancies, especially if
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