The British collaborative study of CD and malignancy coordinated from Northwick Park was published in 1989 , Among 235 coeliac patients with malignancy, 67 had small intestinal lymphoma, 19 had small bowel carcinoma, 10 had carcinoma of the oesophagus and 4 had carcinoma of the pharynx. It was suggested that the risk of oesophageal and pharyngeal cancer might be reduced by a gluten-free diet, similar to the case of small gut lymphoma. Carcinoma of the small bowel as a complication of CD was shown to be the most common invasive malignancy after lymphoma. Anemia is the most usual initial feature and is often associated with blood loss. Weight loss, abdominal pain and intestinal obstruction are other prominent features. Bowel radiology will be helpful in locating the tumor. If the tumor is in the proximal duodenum it may be seen at endoscopy. In cases where the tumor is still confined to the bowel, the resection can substantially prolong the survival.
Cancer of the small intestine is rare compared with other sites in the gastrointestinal tract. Out of the four major primary small bowel tumors (adenocarcinomas, lymphomas, carcinoid, and leiomyosarcomas), adenocarcinomas and lymphomas are associated with diseases that seem to increase the risk of developing these malignancies. Therefore, treatment of the predisposing condition seems to decrease the risk of developing subsequent malignancy.
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