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JAMA Oncology Patient Page
August 2016

Jaundice (Hyperbilirubinemia) in Cancer

JAMA Oncol. 2016;2(8):1103. doi:10.1001/jamaoncol.2016.1236

Jaundice is yellowing of the skin and white of the eye, also called hyperbilirubinemia because the blood contains too much bilirubin, the yellow pigment that causes the discoloration.

What Causes Hyperbilirubinemia?

When red blood cells break down, bilirubin is formed. Bilirubin is part of the bile fluid produced by the liver. A normal liver metabolizes bilirubin to keep blood levels low.

When liver cells are damaged or when cancer has spread to the liver or bile ducts, the function of the liver is reduced. The bilirubin level in the blood then increases, which causes jaundice. Three broad types of liver damage can lead to jaundice:

  • Prehepatic causes occur from massive breakdown of red blood cells, producing bilirubin in such large quantities that the liver is unable to keep up with its processing. Consequently, large amounts of unprocessed bilirubin pass through the liver and into the blood.

  • Hepatic causes refer to direct damage to the liver cells themselves from such causes as hepatitis virus infection, toxins like alcohol, some chemotherapy drugs, and cancer of the liver.

  • Posthepatic causes occur after bilirubin has been processed in the liver but is unable to pass out of it. This occurs in patients with gallstones or cancers blocking bile ducts, leading to a backlog of bile, which then spills into the bloodstream.

What Are the Other Symptoms of Hyperbilirubinemia?

Patients with hyperbilirubinemia also have dark yellow urine, pale stools, and skin itching. Some people have nausea, vomiting, and pain in the abdomen, as well as vague symptoms like headache, weight loss, and abdominal bloating.

The liver removes toxic substances from the body. When the liver cannot work well, toxic ammonia also builds up in the blood stream and it can go to the brain, leading to poor brain function. This is called hepatic encephalopathy, which causes confusion, fatigue, and drowsiness.

What Cancers Can Cause Hyperbilirubinemia?

Cancers that arise from the liver, such as hepatocellular carcinoma, or spread to the liver, such as pancreatic or colon cancer, are the most common causes of jaundice among patients with cancer.

What Is the Workup for Jaundice?

The workup for jaundice includes blood tests of liver function studies, viral hepatitis studies, and urine tests.

The area around the liver and gall bladder can be studied with imaging studies such as an ultrasound, CT scan, or MRI scan of the abdomen. Doctors sometimes order a procedure called endoscopic retrograde cholangiopancreatogram (ERCP), in which the bile ducts are examined using an endoscope.

How Is an Elevated Bilirubin Level Treated?

Treatment of jaundice is based on the cause of the elevated bilirubin level. If it is caused by viral hepatitis, the doctor may prescribe antiviral medications. In cases of blockage of the bile ducts, surgery may be performed to remove the gall bladder or the tumor causing the blockage. Using an ERCP procedure, a doctor may insert plastic or metal tubes called stents inside the bile ducts to prevent them from collapsing and ensure normal bile flow.

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Section Editor: Howard (Jack) West, MD.
The JAMA Oncology Patient Page is a public service of JAMA Oncology. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA Oncology suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call (312) 464-0776.
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Article Information

Published Online: July 14, 2016. doi:10.1001/jamaoncol.2016.1236.

Conflict of Interest Disclosures: None reported.

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