Lymphoma and coeliac disease
My father had coeliac disease and he died of T Cell lymphoma. I was recently diagnosed with coeliac disease, and I am worried that I could also get lymphoma. Are the two connected?
Coeliac disease is a disease of the small bowel. It is rare in most of the world. It is more common in northern Europe. The small bowel absorbs many of the nutrients from the food we eat. People with coeliac disease have an immune, or allergic, reaction to gluten. Gluten is a protein found in rye, wheat and barley. The allergic reaction causes inflammation. In time, the inflammation damages the lining of the small bowel. This makes it difficult for the bowel to absorb the nutrients we need from our food. Symptoms of coeliac disease include bloating and discomfort in the tummy (abdomen), diarrhoea, low red blood cell count (anaemia) and tiredness.
Coeliac disease has been associated with an increased risk of developing some types of lymphoma. This was first noted in the 1930s, and was originally associated with a rare type of lymphoma of the small intestine called enteropathy type T cell lymphoma (ETTL). This type of lymphoma is also known as enteropathy associated T cell lymphoma (EATL). More recently, researchers have found that while ETTL is the most common type of lymphoma associated with coeliac disease, there is an increased risk of other types of non Hodgkin lymphomas. We don’t know exactly what the increased risk of lymphoma is. But importantly, most people with coeliac disease do not develop lymphoma.
Compared with the general population, people with coeliac disease also have an increased risk of developing some other cancers, including oesophageal cancer and adenocarcinomas of the small bowel. However, researchers have yet to agree how much the risk is increased, and opinions vary. One study has reported that people with coeliac disease have a lower risk of breast cancer.
This can be a great deal to take in, especially while adjusting to the diagnosis of coeliac disease, and changes to your diet. But it is important to remember that doctors now believe that following a gluten free diet can reduce your risk of developing cancer so that it becomes the same as that of the general population. In 1989 a medical study in Birmingham concluded that people with coeliac disease who had followed a gluten free diet for 5 years or more, had the same risk of cancer as the general population. You can read the results of this study on the BMJ Journals website.
A Swedish study showed that the risk of non Hodgkin lymphoma in people with coeliac disease was significantly higher than in the general population, but the risk fell from the 1970s to the 1990s. This may be because coeliac disease is better managed nowadays and also because milder forms of the disease are picked up through screening.
We need more research to understand more about the cancer risks associated with coeliac disease. We also need to find out whether people with this condition should have cancer screening. If you have coeliac disease, it is important to stick to a strict gluten free diet. This will help reduce problems from other conditions associated with coeliac disease, such as osteoporosis and autoimmune disorders, as well as your cancer risk. If you are worried that you might have coeliac disease, talk to your GP.
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