Jaundice

Jaundice can be caused by certain types of cancer or some cancer treatments. It is a condition that develops when there is too much bilirubin in the blood. If you have jaundice, your skin and the whites of your eyes become yellow, your urine (pee) is dark yellow, your stool (poop) is light-coloured and your skin may be itchy.

Bilirubin is a yellowish pigment found in hemoglobin. Hemoglobin is the protein in red blood cells that carries oxygen and gives blood its red colour.

Our bodies constantly get rid of old red blood cells and make new ones. When old red blood cells break down, they release bilirubin. The liver removes bilirubin from the blood and concentrates it into bile. Bile is stored in the gallbladder and released into the small intestine. Most bilirubin is then removed from the body, mostly in stool but also in urine.

If the body can't get rid of enough bilirubin, it builds up in the skin and eyes. This makes them turn yellow.

There are 3 different types of jaundice. They are based on where the problem with bilirubin starts.

Pre-hepatic jaundice is caused by a problem with the blood before it gets to the liver. If a blood disease or condition causes too many red blood cells to break down at once, then there is more bilirubin in the blood than the liver can remove.

Hepatic (hepatocellular) jaundice is caused by a problem with the liver. If the liver tissues are damaged or scarred (called cirrhosis) and the liver can’t work properly, it can’t make bile to remove bilirubin from the blood.

Post-hepatic (obstructive) jaundice develops when the bile ducts are blocked or damaged so that bile can't get into the intestine to be removed from the body.

Hepatic and post-hepatic jaundice are the types that may be caused by cancer.

Certain types of cancer can cause jaundice:

• liver cancer
• stomach cancer
• pancreatic cancer
• gallbladder cancer
• bile duct cancer
• a type of non-Hodgkin lymphoma (NHL) called diffuse large B-cell lymphoma (DLBCL)
• cancer that has spread (metastasized) from another part of the body to the liver, stomach, pancreas, gallbladder or bile duct

The different types of jaundice can also develop for different reasons.

Pre-hepatic jaundice can be caused by:

• a form of anemia that causes the breakdown of red blood cells (called hemolytic anemia)

• sickle cell disease

• thalassemia

• malaria, which is a blood infection caused by a parasite carried by mosquitoes

Hepatic jaundice may be caused by:

• liver damage from certain immunotherapy and chemotherapy drugs, such as mercaptopurine (Purinethol), thioguanine (Lanvis) and fluorouracil (also called 5-fluorouracil or 5-FU)

• cirrhosis, which can be caused by hepatitis viruses or long-term overuse of drugs and alcohol

• acute graft-versus-host disease (GVHD), which is a complication of an allogeneic stem cell transplant

Post-hepatic jaundice may develop if a bile duct is damaged by liver disease (such as primary sclerosing cholangitis or primary biliary cholangitis). It can also occur when a bile duct is blocked by a tumour or gallstones.

Symptoms can vary depending on the cause of jaundice and other factors. They may include:

• yellowing of the skin and the whites of the eyes
• stool that is pale or light-coloured and smells very foul
• urine that is dark yellow or brown
• itching (often all over the body)
• abdominal pain or tenderness
• blood in vomit or stool
• weight loss
• bruising more easily than usual
• swelling of the legs or abdomen
• fever
• fatigue
• changes in mental alertness, including drowsiness, confusion and agitation

Tell your doctor or healthcare team about any symptoms you have. The sooner you report any symptoms, the sooner they can suggest ways to manage them.

Your healthcare team will try to find the cause of jaundice. You may need to have the following tests.

A complete blood count (CBC) is used to check the level of red blood cells and hemoglobin.

Blood chemistry tests, specifically liver function tests, are done to find out how well the liver is working. Other blood chemistry tests are used to check the levels of sugar and enzymes in the blood, to see how well the blood clots and to check for any infections.

An ultrasound, CT scan or MRI of the abdomen is done to look for a blockage or tumour.

An endoscopic retrograde cholangiopancreatography (ERCP) is used to examine the ducts that drain the pancreas, liver and gallbladder. It may also be used to manage a blockage or obstruction.

A liver biopsy may be done if a mass or abnormality in your liver is seen during imaging.

Find out more about these tests and procedures.

Once your healthcare team knows the cause of jaundice, they can suggest ways to treat it.

When jaundice is caused by a tumour or cirrhosis, treatment may include:

• surgery to remove or go around the blockage
• using ERCP to place a thin plastic or metal tube (called a stent) to allow bile to drain past the blockage through the stent

Jaundice can cause itching. If it does, you can help relieve it by avoiding irritants and keeping your skin cool and moist. You can also try the following to help manage itching:

• Eat a balanced diet and drink plenty of fluids.

• Keep your home at a cooler temperature than usual.

• Bathe less often.

• Use lukewarm water instead of hot water for showers or baths.

• Pat (don't rub) your skin dry and apply lotion right after having a shower or bath.

• Switch to mild, hypoallergenic and unscented soaps.

• Apply hypoallergenic and unscented skin lotions and lubricants several times a day.

• Choose clothing and bedding made of materials that don’t irritate the skin, such as cotton or silk.

• Use a gentle unscented laundry detergent and double rinse your clothes after you wash them.

Your healthcare team can also suggest anti-itching medicines like antihistamines. In some cases, they might prescribe cholestyramine (Olestyr) or an antidepressant to help relieve the itching.