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Background Coeliac disease (CD) has been linked to malignancy, but the strength of this association appears to vary by cancer type. This systematic review and meta-analysis aimed to quantify site-specific cancer risk in adults with CD compared with the general population or non-CD controls.Methods This review was conducted according to PRISMA 2020 guidance and was prospectively registered in PROSPERO (CRD420251038334). PubMed, Embase, and Scopus were searched on 24 April 2025. Eligible studies included adult cohort and case-control designs reporting ORs, RRs, HRs, or SIRs with 95% confidence intervals for cancer outcomes in CD. Two reviewers independently screened studies, extracted data, and assessed risk of bias using ROBINS-I. Effect estimates were harmonised to odds ratios using a rare-disease approximation, and random-effects meta-analyses were performed using restricted maximum likelihood with Hartung-Knapp adjustment. Thirty-one studies contributed 96 study-outcome entries across nine predefined cancer subgroups.Results Of 14,694 records identified, 3,130 duplicates were removed, 11,564 titles/abstracts were screened, and 213 full-text articles were assessed ( IDDF2026-ABS-0337 Figure 1. Prisma diagram). Thirty-one studies met the inclusion criteria. The strongest associations were seen for small bowel cancer (pooled OR 20.52, 95% CI 5.33-78.99) and lymphoma/lymphoproliferative malignancies (pooled OR 7.35, 95% CI 4.57-11.81). Risk was also increased for oesophagogastric cancer (pooled OR 2.01, 95% CI 1.41-2.88) and hepatopancreatobiliary cancers (pooled OR 1.59, 95% CI 1.21-2.08). In contrast, breast cancer risk was lower in CD (pooled OR 0.77, 95% CI 0.63-0.94) (IDDF2026-ABS-0337 Figure 2. Forest plot for risk of breast cancer in celiac disease). No clear association was found for colorectal cancer (pooled OR 1.31, 95% CI 0.70-2.46), prostate cancer (pooled OR 1.02, 95% CI 0.84-1.24), lung/respiratory cancer (pooled OR 0.86, 95% CI 0.67-1.09), or thyroid cancer (pooled OR 1.42, 95% CI 0.23-8.66). Most outcomes showed moderate-to-substantial heterogeneity.Conclusions Adults with coeliac disease have a markedly increased risk of lymphoma and small bowel cancer, with more modest increases in oesophagogastric and hepatopancreatobiliary cancers, while breast cancer risk appears reduced. These findings support a cancer risk profile in CD that is site-specific rather than uniform across malignancies.Abstract IDDF2026-ABS-0337 Figure 1Abstract IDDF2026-ABS-0337 Figure 2