One of the jobs of the liver is to process bilirubin, a yellow pigment formed when red blood cells in the body break down. Normally, the bilirubin passes from the liver, through the bile duct to the bowel, and then out of the body in faeces (poo).
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What causes jaundice?
With liver cancer, bilirubin sometimes builds up in the blood. This can be because the cancer has blocked a bile duct, the liver is not working properly (progressive liver function failure), or the liver has been replaced by widespread tumour. The build-up of bilirubin in the blood is known as jaundice. It can cause yellowish skin and whites of the eyes, itchy skin, pale faeces or dark urine.
How can it be relieved?
Jaundice can sometimes be relieved by unblocking the bile duct with a small tube made of plastic or metal called a stent. Symptoms of jaundice usually go away 2–3 weeks after the stent is inserted. Stenting is not always recommended in advanced cancer.
The itching caused by jaundice is often worse at night. It can be relieved to some degree by keeping your skin moisturised. Try to avoid alcohol, spicy food, hot baths and direct sunlight, which can make the itching worse. Your doctor can prescribe medicine if the itching continues and is uncomfortable.
How stents are inserted
A stent can be placed in your liver to open a blocked bile duct and relieve symptoms of jaundice. The earlier the stent is inserted, the less severe the symptoms. Stenting can be done in two ways.
Endoscopic stent placement
You may have the procedure as day surgery or you may need to stay in hospital overnight. You will have a local anaesthetic and may have a sedative to help you relax.
A gastroenterologist or surgeon will insert a long, flexible tube with a camera and light on the end (endoscope) through your mouth, stomach and small bowel into the bile duct. Pictures show up on a screen so the doctor can see where the blockage is and where to put the stent. The stent is put into the bile duct using the endoscope, which is then removed.
Recovery from an endoscopic stent placement is fairly fast. Your throat may feel sore for a short time. There is a risk that the bile duct may become infected and the pancreas may become inflamed – your doctor will talk to you about what can be done if this occurs.
Percutaneous stent placement
Sometimes a stent cannot be inserted using an endoscope so it is placed through the skin of the abdomen, using ultrasound and x-rays for guidance. This requires a small operation.
The operation may be done under general anaesthetic or heavy sedation, and you will usually stay in hospital overnight. You may have a small plastic tube (drain) coming out through the skin for some days. This lets fluid drain from the area.
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Dr David Yeo, Hepatobiliary/Transplant Surgeon, Royal Prince Alfred, Chris O’Brien Lifehouse Cancer Centre and St George Hospitals, NSW; Dr Lorraine Chantrill, Head of Department Medical Oncology, Illawarra Shoalhaven Local Health District, NSW; Michael Coulson, Consumer; Dr Sam Davis, Interventional Radiologist, Staff Specialist, Royal Brisbane and Women‘s Hospital, QLD; Prof Chris Karapetis, Network Clinical Director (Cancer Services), Southern Adelaide Local Health Network, Head, Department of Medical Oncology, Flinders Medical Centre and Flinders University, SA; Dr Howard Liu, Radiation Oncologist, Princess Alexandra Hospital, QLD; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Lina Sharma, Consumer; Dr Graham Starkey, Hepato-Biliary and General Surgeon, Austin Hospital, VIC; Catherine Trevaskis, Gastrointestinal Cancer Specialist Nurse, Canberra Hospital and Health Services, ACT; Dr Michael Wallace, Western Australia Liver Transplant Service, Sir Charles Gairdner Hospital, WA.
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