A 45-year-old woman visits her primary care physician for her annual exam. She reports a recent history of unexplained weight loss, frequent diarrhea, and feeling generally unwell over the past few months. On physical examination, the physician notes a skin rash on her elbows, which the patient describes as itchy and occasionally blistering. She also reports a history of recurrent miscarriages. Her family history is significant for a mother and sister with similar gastrointestinal and dermatological symptoms. Based on these findings, the physician suspects a certain disease and advises the patient to avoid gluten in her diet. This disease is associated with a significant increase in what type of cancer?
A. Breast cancer
B. Lung cancer
D. Ovarian cancer
E. Prostate cancer
The patient's symptoms - unexplained weight loss, diarrhea, a blistering rash on the elbows (dermatitis herpetiformis), and a history of recurrent miscarriages - point to celiac disease. Celiac disease is an autoimmune disorder triggered by ingestion of gluten, a protein found in wheat, barley, and rye. In genetically predisposed individuals, gluten ingestion leads to an inflammatory response in the small intestine, resulting in malabsorption of nutrients. The disease is also associated with an increased risk of malignancy, especially non-Hodgkin lymphoma, which is why choice C is the correct answer. The increased risk of lymphoma in celiac disease may be due to chronic inflammation or a direct effect of gluten on lymphoid tissue.