July 03, 2007

Jaundice, Liver cancer


Jaundice is characterised by a yellowish tinge to the skin and eyes. About six out of 10 newborns have jaundice to varying degrees, while the condition is more common among premature babies. Jaundice is caused by an excess of a chemical called bilirubin, which is normally eliminated by the liver. However, a newborn's liver takes a few days to process this chemical. If the baby is full term and healthy, mild jaundice is nothing to worry about and will resolve by itself within a week or so. However, a premature or sick baby, or a baby with very high levels of bilirubin, will need close monitoring and medical treatments. Other causes of jaundice in babies include blood group antibodies (Rhesus factor & ABO incompatibilities), haemolytic anaemia, hepatitis and galactosaemia.

The symptoms of jaundice depend on the cause and severity, but may include:

Yellow tinge to the skin, usually appearing first on the skin of the face and scalp.
Yellow tinge to the white parts of the eyes (sclera).
In moderate jaundice, the yellow tinge will spread to the skin of the body.
In severe jaundice, the palms of the hands and soles of the feet will turn yellow.
Unusual drowsiness.
Feeding difficulties.
In some cases, light-coloured faeces and dark urine.

Physiological jaundice explained
Red blood cells are red because of the protein haemoglobin. Old and damaged red blood cells are broken down into their chemical components, which are then either recycled or eliminated from the body as waste. The chemical bilirubin is produced as a by-product when haemoglobin is metabolised (used) by the body. The liver helps to eliminate bilirubin as waste. In utero, the baby's bilirubin is sent down the umbilical cord and eliminated by the mother's body. After birth, the baby's liver has to eliminate the bilirubin. A baby's liver may take a few days to function at full speed; in the meantime, the excess bilirubin in the baby's body causes the characteristic symptoms of jaundice. Every newborn has elevated bilirubin, but only around 60 per cent of full term babies will have noticeable symptoms. Treatment isn't usually necessary, unless the baby has very high bilirubin levels, or is premature or sick.

Other causes of jaundice
Jaundice can also be caused by a range of other conditions and events including:
Breast milk - the mother's breasts produce small amounts of colostrum in the first few days after childbirth. Until the milk comes in, the limited amounts of fluid received from breastfeeding may hinder the functioning of the baby's liver. Certain enzymes in breast milk are also thought to contribute to 'breast milk jaundice'.

Neonatal hepatitis - some of the viruses that can trigger hepatitis in babies include cytomegalovirus, rubella, and hepatitis A, B and C. In around eight out of 10 cases, the cause isn't known but viral infections are suspected. The baby was either exposed to the viral infection in utero, or within the first month or so of life.

Rhesus and ABO blood group incompatibilities - the mother may produce antibodies that can attack the baby's red cells during the latter stages of pregnancy. This means that higher than normal levels of damaged red blood cells have to be eliminated from the body, which in turn triggers high bilirubin levels. The baby may be born anaemic and develop severe jaundice within hours of birth.

Haemolytic anaemia - the inherited types of haemolytic anaemias are autoimmune disorders, characterised by the destruction of red blood cells by the immune system. Haemolytic anaemia can be a complication of other disorders, such as malarial infection.

Galactosaemia - galactose is a milk sugar. A baby with galactosaemia lacks the enzyme needed to metabolise galactose. The high levels of milk sugar can cause cirrhosis of the liver and subsequent jaundice.
Biliary atresia - the ducts that allow the flow of bile from the liver to the small intestine are destroyed, for reasons unknown. Without bile ducts, bile accumulates within the liver and causes the characteristic symptoms of jaundice.

Diagnostic methods
The underlying cause of jaundice in babies must be found. Some of the diagnostic tests may include:
Physical examination
Blood tests
Ultrasound scans
Liver biopsy
Exploratory surgery.

Treatment options
Treatment for jaundice in babies depends on the cause, but may include:
Mild physiological jaundice - if the baby is otherwise healthy and well, no treatment is necessary. The baby's liver will take only a few days to process bilirubin properly.

Moderate to severe physiological jaundice - options may include phototherapy (light therapy). This helps to transform the bilirubin in skin into a less harmful chemical. In severe cases, a blood transfusion may be needed, but this is very uncommon.
Breast milk jaundice - breastfeeding is almost always continued. Phototherapy is usually the primary treatment.

Neonatal hepatitis - there is no specific medical treatment. Options may include vitamin and mineral supplements, or drugs to improve the flow of bile.

Haemolytic anaemia - treatment depends on the cause. For example, infection with malarial parasites can cause haemolytic anaemia and treatment includes anti-malarial medications.

Galactosaemia - the principal treatment is to make sure the baby's diet contains no galactose or lactose (another milk sugar). Typically, this means stopping breastfeeding and necessitates the use of special formulas.

Biliary atresia - involves surgery to connect a tiny section of the liver to the small intestine to allow bile to drain effectively. Around 75 per cent of patients will experience good to moderate bile flow. For the remainder, the only option may be a liver transplant.

Things to remember
Jaundice is characterised by a yellowish tinge to the skin and eyes.
About six out of 10 newborns have jaundice to varying degrees.
Jaundice is caused by an excess of a chemical called bilirubin.
Physiological jaundice will resolve by itself once the baby's liver is functioning at full speed.
Other causes of jaundice include haemolytic anaemia, hepatitis and galactosaemia.


Liver cancer can be a primary cancer (starts in the liver) or a secondary cancer (starts in another part of the body and spreads to the liver). Primary liver cancer is one of the less common cancers in Victoria. Secondary liver cancers are the most common liver cancers. Liver cancer usually has no symptoms in the early stages.

Functions of the liver
The liver is the largest organ inside the body. It is located on the right hand side of the abdomen and is protected by the ribcage. The liver will function normally with only a small portion of it in working order. Its functions include:

Destroying harmful substances, such as alcohol, and getting rid of waste products.
Converting food containing fats and sugars to be used by the body for energy.
Producing bile to help the digestion of food.

Primary liver cancers
Primary liver cancer is one of the less common cancers in Victoria with about 240 people diagnosed each year. It is more common in men, and people aged over 65 years. Most primary liver cancers start in liver cells (hepatocellular carcinoma); others start in a bile duct (cholangiocarcinoma).

In the western world, most people who develop primary liver cancer also have cirrhosis of the liver. This is scarring of the liver due to causes including heavy alcohol drinking over a long period of time. However, only a small number of people who have cirrhosis of the liver develop primary liver cancer. Infection with hepatitis B, C or D can also increase the risk of cirrhosis and, later, primary liver cancer.

Secondary liver cancers
Secondary liver cancer is the most common liver cancer. A secondary liver cancer starts somewhere else in the body and spreads (metastasises) to the liver. Most cancers can spread to the liver but the common ones are breast, stomach and bowel cancers. These liver cancers are named after the primary cancer for example breast cancer that has spread to the liver is called metastatic breast cancer. Sometimes the liver cancer is discovered first, which leads to the diagnosis of the primary cancer.

Liver cancer usually has no symptoms in the early stages. Symptoms can include:
Pain in the upper right side of the abdomen
Yellowing of the skin and eyes (jaundice)
Weight loss
Loss of appetite
Swelling of the abdomen.

Diagnosis methods
Liver cancer is usually diagnosed with a number of different tests, which may include:
Blood tests - to check your general health and to check for a chemical usually found in increased levels in people with primary liver cancer.

Ultrasound - a picture of the liver is taken using sound waves.
CT scan - a specialised x-ray taken from many different angles to build a three-dimensional (3-D) picture of the body.
Magnetic resonance imaging (MRI) - similar to a CT scan, but uses magnetism instead of x-rays to build a picture of the body.

Liver biopsy - a small piece of liver tissue is removed with a needle and examined for cancer cells.
Laparoscopy - a small cut in the lower abdomen allows a thin mini-telescope (laparoscope) to be inserted to look at the liver and take a sample of the liver tissue.

If the tests show you have secondary liver cancer, you may need further tests to find out where the primary cancer is.

Treatment options
Treatment for liver cancer will depend on whether it is a primary or secondary cancer. Treatment options may include:
Surgery - to remove the cancer and damaged tissue. This is the main treatment for primary liver cancer. Surgery is only useful for secondary liver cancer if the cancer cells only affect one part of the liver.
Chemotherapy - the use of tablets or injections of anti-cancer drugs. Sometimes they are injected directly into the artery that feeds the cancer in the liver. Chemotherapy is the main treatment for secondary liver cancer and sometimes used for primary liver cancer.

Radiotherapy - x-rays are used to target and kill cancer cells. Radiotherapy may help in treating some types of primary liver cancers and may be used to relieve symptoms of pain and discomfort from secondary liver cancer.
When a cure isn't possible

If liver cancer has been diagnosed in its later stages, the cancer may have spread to the point where a cure is no longer possible. Treatment then focuses on improving quality of life by alleviating the symptoms. Options may include medications such as painkillers.

Things to remember
The liver will function normally with only a small portion of it in working order.
Most liver cancers are secondary liver cancers, which means a cancer that starts somewhere else in the body and spreads to the liver.

Adapted from: Better Health Channel