Gastrointestinal cancer in celiac disease: 'the first days are the hardest days, don't you worry anymore?'.

摘要

The risk of developing cancer or lymphoma is a major concern for individuals with celiac disease, and fear of malignancy is one factor that encourages gluten-free diet adherence. This concern appears well-founded because multiple previous studies have confirmed an elevated risk of lymphoid and certain non-lymphoid gastrointestinal malignancies in patients with clinically detected celiac disease. There is also a mechanistic rationale for elevated risk of malignancy in celiac disease. An increased risk of lymphoid malignancies, most commonly non-Hodgkin lymphoma, is a characteristic of many autoimmune disorders. This increased lymphoma risk is generally believed to be a consequence of lymphocyte hyperstimulation and the accumulation of chromosomal and other genetic abnormalities that, over time, lead to uncontrolled proliferation. More recently, it has also been suggested that genetic factors that predispose to autoimmunity might independently predispose to risk of lymphoid malignancy. The causes of elevated risks of non-lymphoid malignancies in celiac disease are less well-understood, although some cancers such as small intestinal adenocarcinoma are likely due to chronic intestinal inflammation, analogous to the development of colonic adenocarcinoma in chronic ulcerative colitis.