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What Does High Bilirubin Level In A Colon Cancer Patient Indicate?

Posted on Wed, 1 Jul 2015

Question: Bilirubin high in metastic colon cancer pt ?

Answered by Dr. Dr. Muhammad Sareer Khalil (37 minutes later)

Brief Answer:
Poor prognosis

Detailed Answer:
Hello and Welcome

I appreciate your concern

Metastatic colon cancer with a rising bilirubin indicates liver failure due to metastases. The prognosis with a rising bilirubin level is poor. Even with chemotherapy, the condition can worsen as many of the chemo agents are toxic to the liver and/or kidneys. Other parameters of liver function along with an ultrasound abdomen can be done in consult with your oncologist.

Let me know if you have any query

Wishing you best of health

Thanks

Dr. M.S. Khalil

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Muhammad Sareer Khalil (32 minutes later)

All other liver tests are normal . But bilirubin is increasing . Ultrasound showed no bile blockage .

Can bilirubin alone b liver failure ?

Answered by Dr. Dr. Muhammad Sareer Khalil (8 hours later)

Brief Answer:
Explained

Detailed Answer:
Hello.

No, bilirubin alone cant be used to determine a failing liver but it is an indication. Pro thrombin and Albumin should be done as both are short and long term synthetic markers of the liver. Encephalopathy evidence is determined clinically to look for liver failure.

Let me know if you have any query

Wishing you best of health

Thanks

Dr. M.S. Khalil

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Muhammad Sareer Khalil (37 minutes later)

All others are normal except bilirubin.

So
Hat exact can be causing bilirubin to go high like this . It's rising every 2 days.?

He has 3 liver mets and 1 is 8 cm but ct scan after chemo showed disease stable .

Answered by Dr. Dr. Muhammad Sareer Khalil (33 minutes later)

Brief Answer:
Please Upload the labs.

Detailed Answer:
Hello.

Could you let me know the albumin and PT levels ? If you can upload the ultrasound and CT scans along with liver function tests , I would be in a better position to assess.

Thanks

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Muhammad Sareer Khalil (6 hours later)

Ok will try upload .so what happens if bilirubin just continues to increase and no
Blocked bile duct ?

Answered by Dr. Dr. Muhammad Sareer Khalil (3 hours later)

Brief Answer:
Intra hepatic cholestasis

Detailed Answer:
Hello.

If upon ultrasound there is no dilated common bile duct then it could be due to intra hepatic cholestasis in which Common bile duct remains normal. PTC can be done in case of intra hepatic cholestasis for the diagnosis. An infection e.g Collitis could also be complication the matters in addition to the metastases and chemo. They can lead to inability of the liver to get the bile through to the CBD.

Thanks.

Dr. M.S. Khalil

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Muhammad Sareer Khalil (8 hours later)

Yes no blockage on ultrasound . He did have a inflammed bowel ( colitis they call it ) for which was in hosp 2 weeks on antibiotic .

Can that cause this ?

During chemo he never had abnormal reading at all .

Is it abnormal to shoot up this much this quick -

Last week was 31
Friday 51
Sunday 74
Monday 85

What if keeps rising and rising , what eill happen ?

Answered by Dr. Dr. Muhammad Sareer Khalil (5 hours later)

Brief Answer:
Explained

Detailed Answer:
Hello.

You need to understand that the chemotherapy that he underwent for the metastatic colon carcinoma does not have a predictable out come. The fact that bilirubin is rising indicates a failure of its normal emptying. Its unlikely to be due to hemolysis as there the liver is fine enough and bilirubin may rise to 5 or 6 range. The infection is a possible cause as well as aggravating factor. Taking in consideration the bilirubin steady rise, a PTC should be performed as its not normal for such a rise. If the bilirubin keeps rising it would be taken as an indication of worsening liver function and can manifest as severe jaundice. Either its the metastases related damage or its the intrahepatic cholestasis that is responsible for the rise.

Thanks.

Dr. M.S. Khalil

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar