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Intestinal Cancer and Celiac Disease

 

What is intestinal cancer?
Cancer of the small intestine is a rare form of cancer typically caused by four types of tumors or classifications. The most common type of small intestine cancer is adenocarcinoma. Other, less common types are: carcinoid tumors, gastrointestinal stromal tumors and lymphomas.

Celiac Disease and Small Intestinal Cancer:
If a person with celiac had the disease undiagnosed for a long period of time, or fails to maintain a gluten-free lifestyle after diagnosis, the chance of developing small intestinal cancer increases. Those with celiac disease are especially more likely to develop lymphomas in the small intestine because of their compromised immune system. In the past the increased risk of celiacs developing lymphomas was quite high, 40-100% more likely. However, more recent studies have shown that the risk of lymphoma is slightly higher than the normal population—much less than previously believed—and that this risk reaches unity with the normal population after a gluten-free diet has been maintained for several years.

Types of Intestinal Cancers:

  • Adenocarcinoma: A type of cancer that begins in the lining of the small intestine, usually the duodenum. Adenocarcinomas make up 40-50% of all small intestinal cancers.

    Who Gets Adenocarcinoma?
    This type of intestinal cancer occurs most often in men later in life, the average age being 60 years. People with Crohns Disease and certain other inherited conditions—such as familial adenomatous polyposis and Peuts-Jegherssyndrome are at a higher risk of developing adenocarinomas.
     
  • Carcinoid Tumors: Occurs when neuroendocrine cells grow abnormally, carcinoid tumors may also be refered to as neuroendocrine tumors or less aggressive neuroendocrine cancer. Carcinoid tumors often cause symptoms throughout the entire body, rather than just in the affected organ.

    Who Gets Carcinoid Tumors?
    People with a family history of multiple endocrine neoplasia—a rare inherited disease that causes increased risk of getting tumors in certain glands, or those with a family history of neurofibromatosis. Carcinoid tumors are more common in women and among African Americans. People with certain diseases that damage the stomach and reduce the amount of stomach acid have an increased risk of developing carinoid tumors.
     
  • Gastrointestinal Stromal Tumors: These are fairly rare tumors that are now believed to start in the interstitial cells of Cajal (ICCs) in the walls of the GI tract. Some stromal tumors are benign.

    Who Gets Stromal Tumors?
    There are very few known risk factors that cause stromal tumors, it is believed that a family history of neurofibromatosis or familial gastrointestinal stromal tumor syndrome will increase a person's risk of getting stromal tumors.
     
  • Lymphomas: Cancer of the lymphatic system that begins in the lymphoid tissue.

    Who Gets GI Lymphomas?
    Most patients have no known risk factors, old age seems to be the greatest factor in developing lymphomas. Some genetic risks factors that cause abnormal function of the immune system can also lead to lymphomas, as well as a diet high in animal fat and low in fruits and vegetables. Exposure to radiation and certain chemicals can increase the risk of lymphomas. Immune deficiencies—from organ transplants, etc, autoimmune diseases, and some infections can also increase the likelihood of a lymphoma developing.

What are the Symptoms of Intestinal Cancer?
Symptoms tend to be vague and unspecific. Complaints are often for pain throughout the body, not just focused in the digestive tract area. Abdominal pain and unexplained weight-loss are the two most common symptoms of intestinal cancer. Other symptoms include, but are not limited to, pain or cramping in the middle of the abdomen, a lump in the abdomen, blood in the stool, nausea, bloating, iron deficient anemia and jaundice.

Screening and Diagnosis of Intestinal Cancer
If your doctor suspects intestinal cancer they might order a barium contrast study, an upper GI tract endoscopy, an ultrasound or a colonoscopy depending on what type of cancer is suspected and the likely location. If tumors are found a biopsy will be performed to confirm that the cells are cancerous.

Treatment of Small Intestinal Cancer
The most common method of treatment of small intestinal cancer is surgery. The doctor will remove all of the visible tumor and some of the surrounding healthy area to ensure that all cancer has been removed. With lymphomas, the most common treatment is radiation therapy.

Celiac Disease and Other Malignancies

Although cancers of the small intestine might seem to be the only related malignancy with celiac, other studies have shown relations with other types of cancer. There is some evidence that patients with celiac have an increased risk of esophageal and pharyngeal carcinomas, a Swedish study found celiac 2.3 times more likely to develop these carcinomas. The same study also found an increased risk for colorectal cancer (SIR=1.5), however an English study found NO patients with celiac disease and colorectal cancer. Celiacs also seem to have an increased risk of developing primary liver cancer. Breast cancer, on the other hand, is seen at a much lower frequency in celiacs than among the general population. This is possibly related to a lower frequency of smoking or lower body weight in celiacs.

The development of malignancies is rare, and although celiac disease does appear to coincide with increased frequencies of certain cancers it is by no means a common occurrence. If you suspect that you might have cancer, or are worried about developing cancer in the future, please discuss your concerns with your physician.

References:

Coeliac disease and lymphoma,
European Journal of Gastroenterology and Hepatology, 2006 18:131-2.
Kumar, Parveen.
Revolution Health
Healtwise/WebMD

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