Research indicates that any increased cancer risk for people with coeliac disease is much lower than previously believed and following a gluten free diet further reduces this already low risk.

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

• Cancer of the small bowel, often referred to as adenocarcinoma 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, lymphoma of the small bowel is rare in the UK, even for those with untreated coeliac disease, and the majority of people with coeliac disease do not develop lymphoma or the other cancers that are associated with coeliac disease.

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 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.

It is not clear from research evidence whether people with dermatitis herpetiformis also have an increased risk of any form of cancer.

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 exact cause of many 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.