Researchers find no link between coffee drinking and the risk of colorectal cancer

Analysis of data from two large population studies -- the Nurses' Health Study (women) and the Health Professionals' Follow-up Study (men) -- showed no correlation between consumption of coffee or tea or amounts of caffeine intake and incidence of colorectal cancer.

Questionnaires from the Nurses' Health Study were assessed and updated every two to four years from 1980 through 1984. The study of men gathered information in 1986, 1990, and 1994. Cancer of the colon or rectum was found in about 1,500 people through 1998.

However, Karin Michels, Sci. D. and her team from Brigham Women's Hospital and Harvard Medical School in Boston did find that drinking 2 cups a day of decaffeinated coffee reduced the risk of getting rectal cancer by about half.

The team cautioned that the reduced incidence of rectal cancer might be due to lifestyle differences rather than the action of decaffeinated coffee itself.

The study results were published in the February 16, 2005 issue of the Journal of the National Cancer Institute. (Vol. 97, No. 4, 282-292)

Read a press release from the Journal of the National Cancer Institute.

Read an abstract of the study in the Journal of the National Cancer Institute.

Does removal of the primary colorectal tumor spur growth of distant metastases?

Pathologists in the Netherlands, led by Charlotte F.J.M. Peeters, M.D. measured levels of anti-angiogenic factors in blood and urine and metabolic activity of liver metastases in patients before and after removing primary tumors in the colon or rectum.

They found that after surgery metabolic activity in the liver mets increased and levels of two circulating anti-angiogenic factors (angiostatin and endostatin) dropped.

They concluded that, "This finding indicates that the primary tumor suppressed angiogenesis in its distant metastasis, and that removal of the primary lesion caused a flare-up in vessel reformation and, thus, enhanced metabolic activity in its liver metastasis."

A previous study by Dr. Peeters showed increased blood vessel development in liver metastases in patients where the primary tumor had been removed compared to patients where the primary tumor had been left in place.

That research concluded, "Our data show for the first time in humans that the presence of a primary tumor is correlated with decreased vascularization of its distant metastases. Resection of the primary tumor results in an increased vascularization of metastatic lesions."

Read the abstract of the study of reduced anti-angiogenic factors in Surgery, February 2005, Volume 137, No. 2.

Read the abstract of the study of increased blood vessel development in the International Journal of Cancer, November 20, 2004.

NEWS FROM ORLANDO -- Abstracts and presentations from the 2005 Gastrointestinal Cancers Symposium in Orlando, Florida in January.

Adding gabapentin (Neurontin) to FOLFOX regimen did not protect against neurotoxicity


Paul Mitchell and his colleagues treated an initial group of 40 patients with advanced colorectal cancer with a modified FOLFOX regimen and another group of 41 with the same FOLFOX regimen plus daily gabapentin. Gabapentin dosage began at 300 mg and was increased as necessary up to a maximum dose of 1800 mg. Treatment continued until disease progressed or toxicity became unacceptable.

There were no significant differences in the number of treatment cycles for each group (10 for the FOLFOX only and 9 for FOLFOX plus gabapentin). Fifty-five percent of patients on FOLFOX alone required at least a 10% reduction in the dose of oxaliplatin compared to 50% of those receiving gabapentin, but this was not significant, nor was the difference of 19% requiring a treatment delay because of toxicity compared to 14% of those in the gabapentin cohort.

Responses were seen in 48% of patients in both groups. Thirty-six percent of the FOLFOX only group had to stop treatment because of toxicity, almost identical to the 37% in the gabapentin group.

The researchers concluded, "Addition of G to FOLFOX does not improve ability to deliver protocol-specified treatment and does not significantly reduce either severity or duration of neurotoxicity."

Read the abstract on the ASCO web site.

No difference found in survival rates for young rectal cancer patients compared to older ones

Despite a general belief that young rectal patients have worse survival than older patients, a study that reviewed data for patients aged 20 to 40 and older patients aged 60 to 80 found no difference in either overall survival or survival by stage.

The younger patients often were diagnosed at a later stage and had more poorly differentiated tumors. There were more black and Hispanic patients in the younger group. Both groups had similar rates of surgery, 85% in both, but younger patients were more likely to have received radiation.

SEER ( Surveillance, Epidemiology, and End Results) data from 1991 to 1999 was studied by Jessica B. O'Connell and her colleagues from the Departments of Surgery at the University of California at Los Angeles and the VA Greater Los Angeles Healthcare System.

Their results are published in Diseases of the Colon and Rectum, December 2004 (Volume 47, Number 12, pp 2064-2069.)

Read the study abstract in Diseases of the Colon and Rectum.

Increased risk of colon cancer in the proximal colon among women with type 2 diabetes

A review of colorectal cancer identified in 870 women in the Iowa Women's Health Study, which includes 14 years of follow-up of over 32,000 women, showed a modestly increased risk for colon cancer in those with type 2 diabetes.

Researchers at the Mayo Clinic and the University of Minnesota compared reports from women in the study who had been diagnosed with adult-onset diabetes with the Iowa cancer registry. After adjusting for age and body mass index, they found that women with diabetes had a 1.4 relative risk of having colorectal cancer. However, this risk was greater in the proximal colon -- that part of the colon closest to the small intestine -- than in the distal colon or rectum. There was no significant increase in risk for either the distal colon or rectum.

In a published report in Cancer Epidemiology, Biomarkers, and Prevention (Vol. 14, 133-137, January 2005) Paul J. Limberg and his colleagues concluded, "this finding implies that CRC prevention strategies among type 2 DM patients should include examination of the proximal colon."

Read an abstract of the study in Cancer Epidemiology, Biomarkers and Prevention.

Should CT-scan be considered for routine follow-up of stage II and III colorectal cancer?

Current guidelines of the American Society of Clinical Oncologists do not recommend routine CT-scans as part of a follow-up surveillence program for patients whose colorectal cancer has been completely surgically removed. However, this remains controversal among oncologists, and some believe that such scans would help find isolated metastases when they could be surgically removed, possibly improving chances for long term survival.

Surveillence guidelines at Roswell Park Cancer Institute call for annual CT-scan, even in the absence of increased CEA (carcinoembryonic antigen) levels or symptoms. Researchers at Roswell Park reviewed charts of 203 stage II and III patients with colorectal cancer treated from 1990 through 1995 who had CT-scans either as part of routine surveillence (nondirected) or because of rising CEA, suspicious symptoms, or abnormal colonoscopy, chest x-ray, or laboratory findings (directed).

In the first year, 121 patients had nondirected scans and 7 recurrences (5.8%) were found. The second year, there were 63 nondirected scans with 4 recurrences (6.4%). In all 9.1% (11 of 121) patients had recurrence which was not initially proceeded by symptoms or changes in CEA.

In the group of 42 whose CT-scans followed up symptoms or changes in CEA or other testing, 28 (66.6%) actually had a recurrence.

Six of the 11 patients with recurrences in the first, nondirected group had successful surgery to remove metastases (54.5%) and their median survival was 50 months compared to 10 of 28 (35.7%) successful resections in the second group. Median survival was 35 months.

The study was retrospective and did not include enough patients to show a statistically accurate result, but it led the researchers to suggest that the current surveillence guidelines are worthy of further study. A larger, prospective study with enough participants to answer the question is needed, they concluded.

Amir Mortizavi MD and colleagues at Roswell Park Cancer Institute reported their findings in the February 2005 American Journal of Clinical Oncology 28(1):30-35.

Read an abstract of the study in the American Journal of Clinical Oncology.

Less than half of colorectal cancer patients are getting adequate examination of lymph nodes after surgery

Although guidelines call for retrieving and evaluating at least 12 regional lymph nodes after surgery, researchers at the University of Minnesota found that this is very often not the case. Reviewing nearly 117,000 cases of early stage (I-III) colorectal cancer, they found that only 37% had at least 12 nodes removed during surgery and examined by a pathologist for cancer cells.

Nancy Baxter M.D. and her team used data from the National Cancer Institutes Surveillance, Epidemiology, and End Results (SEER) cancer registry to study patterns of lymph node testing from 1988 through 2001.

Although complete nodal evaluation increased from 1988 when only 32% of patients had at least 12 nodes tested, only 44% were adequately examined by 2001. The median number of lymph nodes retrieved and examined was 9.

Older patients were less likely to have had complete examinations, as were those with left-sided and rectal tumors. 50.5% of patients younger than 50 had adequate testing compared to 35% of those over 70. The researchers did not consider rectal cancer patients who had radiation prior to surgery in their statistics.

Geography made a difference ranging from 33% in the San Francisco/Oakland registry to 53% in Hawaii.

Cancer stage also made a difference with 25% of those at stage I, 41% at stage II, and 46% at stage III with complete evaluation.

Other research has coordinated survival with numbers of nodes removed and tested, with the poorest survival seen when fewer than 6 nodes are removed and the best when more than 25 are examined. In addition, too few nodes make it difficult to decide on the possible value of chemotherapy for stage II cancer.

Baxter and her colleagues reported their study in the February 2, 2005 issue of the Journal of the National Cancer Institute (Vol. 97, No. 3, 219-225).

Read the article abstract in the Journal of the National Cancer Institute.


Read a discussion of the study on Medscape.