Coffee and Colorectal Cancer Here’s What We Know

Coffee. It’s the beverage that helps so many Americans power through a busy day. More than half the population over 18 years of age—that’s over 150 million people—drink three or more cups of coffee every day, at an average of 9 ounces per cup. And another 30% of the population drink it occasionally.

In medical circles, coffee wasn’t always regarded kindly. This beverage was once linked to an increased risk of cancer. But not anymore. Today, coffee has been found to have potentially protective properties in cases of coronary heart disease, stroke, diabetes, kidney disease and liver cancer.

Recently, an interesting study published in JAMA Oncology looked at more than 1100 patients with metastatic colorectal cancer and concluded that “increased coffee consumption at the time of study enrollment was associated with lower risk of disease progression and death. Significant associations were noted for both caffeinated and decaffeinated coffee.”

A happy connection, if it’s indeed true. But can we rely on this study to paint the full picture? Unfortunately, no.

What the study ultimately indicates is that the greatest benefit seems to come in patients who drink more than four cups a day and in women with a normal Body Mass Index (BMI) of 25 or less. Sadly, in the case of patients with metastatic colon cancer, coffee drinkers nevertheless have a low likelihood to achieve a five-year survival rate.

Coffee does have antioxidant, anti-inflammatory properties, and also causes the body to be more sensitive to insulin, all of which can help fight cancer. But the National Institutes of Health continues to state that coffee’s potentially positive effect on the progression of colon cancer remains inconclusive; additional research must be done.

What Exactly Is Colon Cancer?

Colorectal cancer is the third most commonly diagnosed cancer in Americans, according to the American Cancer Society (ACS). In the U.S., the ACS estimates that more than 104,610 new cases of colon cancer and 43,000 new cases of rectal cancer will be diagnosed this year, with existing cases causing well over 53,200 deaths.

Cancer of the colon develops when a growth occurs in the lining of your colon. This growth usually starts out small and non-cancerous, then enlarges over time and can eventually spread to other organs. Early symptoms—blood in the stool or changes in bowel habits—may raise red flags, yet often, the patient is unaware that a cancer threat is present. This is why regular screening is critical.

Lowering the Risk

Here are some key ways to lower your risk of colorectal cancer:

• Maintain a healthy lifestyle and good nutrition: Excess weight, smoking and alcohol consumption are all associated with cancer in general, and with colon cancer in particular. Eating high quantities of red meat, as well as processed meats such as lunchmeats, also increases your risk. Consume nutritious, high-fiber foods to promote good colon health.
• Get screened: New screening guidelines just released by the U.S. Preventive Services Task Force recommend that colorectal screenings begin for everyone at age 45. This is due to the recent rise in this cancer among patients in their mid-to-late 40s.
• Know your family history: A family history of colon cancer or polyps can be a strong predictor, and we screen patients earlier in life if we learn this disease has occurred in their family. African Americans have a higher incidence of colon cancer, as well as a higher mortality rate from it, than the general population.When a patient has been affected by colon cancer, we generally recommend that other family members begin screenings at an age 10 years younger than the family member in whom it occurred. For example, if your father had colon cancer at age 45, we ask you to begin screenings at 35. Then, even if your screening is normal, we’ll continue to screen you every five years, with your family history in mind.

Younger Adults: A Troubling Demographic

Recently, the higher incidence of youth colorectal cancer deaths received national attention with the untimely death of actor Chadwick Boseman. In fact, since the mid-1980s, this cancer has increased in adults ages 20–39 years and, since the mid-1990s, in adults ages 40–54 years.

We don’t yet know why these increases are happening, but we can guess that it involves lifestyle-related trends and the growing phenomenon of diabetes in younger people. Adults in their 20s and 30s are typically unaware of symptoms or unsure why they may be experiencing rectal bleeding. Ongoing research is important to shed light on specific criteria for risk in these age groups.

Happily, with more senior adults, rates of colon cancer have been decreasing, as regular screenings catch potentially pre-cancerous polyps. Of course, for older patients who tend to get a lot of precancerous polyps, we screen even more frequently. If their screening is clean, they don’t have to return for another 10 years.

Screening for Early Detection

Three different types of screening are available:

• Colonoscopy: We recommend that everyone get a colonoscopy every 10 years, beginning at age 45. Colonoscopy is the most accurate and dependable procedure to detect colorectal issues, helping us to easily spot and immediately biopsy or remove polyps. Also, if a patient receives a positive result from other screenings, colonoscopy is a must. It requires some prior preparation by the patient and, because the patient is sedated during the procedure itself, they need someone to transport them to and from the hospital.
• Fecal Immunochemical Test (FIT): The FIT test examines blood rather than DNA. Done yearly, it checks for blood in your stool (although this is certainly not always an indicator of cancer).
• Stool DNA Test: 10 types of larger polyps and tumors secrete certain DNA predictive of colon cancer. For this test, the patient submits a stool sample using a kit such as Cologuard®. The test looks for threatening DNA in the stool, as well as blood. If the test comes up negative, the patient repeats the test in three years.

Which test do we recommend? The one that the patient, regardless of age, is the most comfortable with! While we encourage colonoscopy as the gold standard, the most important thing is that you complete some sort of reliable screening on a regular basis.

When a Growth is Found

If we detect a mass or a large polyp during colonoscopy, we biopsy it to check for abnormalities. We “tattoo” the relevant spot by injecting dye into the colon wall, allowing us to return to that spot when the tissue biopsy is complete. If we suspect the tissue to be cancerous, we send multiple sets of biopsied tissue to a pathologist for diagnosis.

If confirmed to be cancer, the next step is surgery. We want to examine not just the tumor itself but the surrounding piece of colon that is removed with it—usually five centimeters or so on each side of the tumor to ensure that we captured all of it. This also gives the pathologist more tissue to examine for any indication that the cancer may have started to spread.

We determine the stage of the cancer when the pathologist examines the specimen and surrounding tissue. If the tumor has only penetrated part of the colon wall, it is considered to be stage 1; if it has passed through the entire wall, stage 2. In stage 3, it has reached the lymph nodes and, of course, in stage 4, it has ultimately metastasized to other areas of the body.

What to Expect at MedStar Washington Hospital Center

If biopsy results show the presence of cancer, we order additional tests, blood work and scans of the rest of the body, to determine if and where the disease has spread. If the lungs, liver and other areas of the body visible via CT scan appear cancer-free, we surgically remove just the cancerous part of the colon and reconnect the remaining portions.

When screening procedures catch the cancer early, we can typically address it using our minimally invasive surgical procedures, via laparoscopy or robotics. Patients can expect to spend two to five nights in the hospital following their procedure.

At the Hospital Center, our gastroenterology team and colorectal surgeons typically perform our colonoscopies. Then, our surgeons, anesthesiologists and nursing staff are committed to delivering excellent surgical work for patients who need it, as well as our unique, enhanced recovery-after-surgery protocols—preoperative, intraoperative, and post-operative procedures that help decrease patient complications and length of stay. This may include everything from healthy nutritional “pre-hab” shakes before surgery, to a focus on multimodal pain medication that avoids the need for opioids or narcotics post-surgery. And we encourage activity, getting patients up and out of bed quickly so the patient is ready to return home as soon as possible.

Despite COVID-19, the Hospital Center’s colorectal team has resumed normal operations, handling not just cancer cases, but screenings and elective surgeries that manage issues like diverticulitis and inflammatory bowel disease.

If you are in need of attention, please reach out to us for a consultation. Above all, don’t delay your screenings!