Introduction
Jaundice is a common infliction seen in our patients. It may be caused by benign and self – limiting illnesses like viral hepatitis or by cancerous illnesses like pancreatic cancers. Often, it is ignored by the family in the initial days, attributing it to viral illnesses and in many cases, alternative medicines are sought for. Unfortunately, in many cases, precious window is lost and by the time the cancer is diagnosed, it becomes incurable. This blog is an attempt to raise awareness about these cancers so that timely treatment can be availed, and cancer can be defeated.
What are the cancers that cause jaundice?
The list of cancers that cause jaundice is quite towering, however there are few cancers which are seen commonly in practice:
1) Cancer of pancreatic head (Pancreatic cancer)
2) Cancer of peri-ampullary region (Peri-ampullary cancer)
3) Gallbladder cancer
4) Cholangiocarcinoma (Bile duct cancer)
a. Hilar cholangiocarcinoma
b. Intrahepatic cholangiocarcinoma
c. Distal cholangiocarcinoma
Pancreatic cancers and peri-ampullary cancers are commonest of all.
How are these cancers diagnosed?
The presentation of these cancers can be quite subtle, and the initial symptoms are often ignored or attributed to other conditions. Jaundice is seen in almost all these cancers, at some point during the disease progression. Peri-ampullary cancer and hilar cholangiocarcinoma present with jaundice, early in disease course. Pancreatic head cancers and gallbladder cancers are known to present with abdominal pain along with jaundice. Intrahepatic cholangiocarcinoma is known to stay asymptomatic for a long time and usually produces symptoms when the disease has become advanced. Generalized itching can be an early symptom of hilar cholangiocarcinoma. Itching is also seen in other cancers. Patients with periampullary cancers can present with black, tarry stools, fullness of abdomen, nausea, and vomiting (sometimes-blood mixed). Reduced appetite and loss of significant weight generally are harbingers of advanced disease.
Various investigations are carried out to confirm the diagnosis. Blood tests, which include complete blood counts, liver function tests and tumor markers and abdominal ultrasonography form the initial workup. These results of these investigations dictate the next set of investigations which could be CT scan, MRI, Upper GI endoscopy, Endoscopic Ultrasound (EUS) or a PET scan. One or more of these investigations are done to arrive at a diagnosis. Often, a biopsy may be required to confirm the diagnosis.
What next?
The goals of the investigations are
1) To arrive at a diagnosis
2) To stage the disease – local and distant
Once we know the diagnosis and stage of the disease, the treatment options are considered. Surgery is the mainstay therapy for cure of these cancers. Chemotherapy and radiotherapy play an important supportive role in cure and maintenance of long-term cancer free survival.
The surgical options are tailored as per the cancer and its organ of origin. While pancreatic and peri-ampullary cancers may require a surgery called ‘Whipple’s pancreaticoduodenectomy’, Cholangiocarcinoma and Gallbladder cancers most often require a part of liver to be resected to achieve cure. Chemotherapy and/or radiotherapy may be required before or after the surgery as per the stage of the cancer. Symptoms of an inoperable cancer can be palliated by chemotherapy.
Long-term prognosis and follow-up
While some of these cancers like pancreatic cancers and gallbladder cancers are known to have a very dismal 5-year survival rate, others like peri-ampullary cancers can have good long-term survival. Even after a surgery is done, it is important to stay in regular follow-up as these tumors can recur. Early diagnosis and timely treatment can provide a reasonable long-term survival to such patients.
