How do we deal with jaundice as my husband has turned very yellow but otherwise feels fine? Is the jaundice itself life threatening if not dealt with immediately?
Husband got his biopsy a week ago but we’re told 7-10 days for the results and he can’t begin treatment until we know what type of tumour we’re dealing with. Very frustrating because in the meantime he is losing weight but thankfully no pain, just some discomfort in his belly and heartburn at night, and of course, the jaundice.
Thank you for reaching out to us with your question; we are so sorry to hear about your husband's situation.
Jaundice is a sign of injury in the liver and a backup of the bilirubin that usually drains through the bile ducts. In cancers in and around the liver, including cholangiocarcinoma, jaundice is often due to compression of the usual outflow that causes obstruction and instead of leaving the body, the bilirubin ends up in the blood and tissues where it is seen as a yellow coloring in the skin and eyes.
How dangerous it is depends on the level in the blood that can be measured, and also how much damage the liver has sustained. In newly discovered cancers where obstruction is the usual cause of jaundice, it can be reversed with a temporary stent that holds the ducts open, allowing the bilirubin to exit as bile. A surgeon or interventional radiologist can insert the stent, often through a non-invasive procedure such as ERCP. Sometimes, a drain needs to be inserted to temporarily allow the bilirubin containing bile to drain.
We recommend contacting your husband's doctor(s) to make sure they are aware of the jaundice. If it hasn't been checked in several days, a blood test can help know how serious the situation is, and regardless, we recommend discussing the possibility of a stent with the doctor(s), while awaiting the diagnosis.
Did you know that genetic analysis of the tumor, even while it is being diagnosed, can be very helpful in cholangiocarcinoma? Specific alterations such as FGFR2, which is frequently found in cholangiocarcinoma, can be targeted with medicines that inhibit this pathway. Therefore, while enduring this difficult waiting period, we recommend asking his doctor(s) to make sure tumor sequencing with next gen sequencing has already begun.
Finally, if you are able to seek a second opinion in the US, we recommend making an appointment with Dr. Mayo at OHSU in Portland, Oregon. You can see his information here: https://www.ohsu.edu/people/skye-c-mayo-md-mph-facs. He is running an innovative trial that looks potentially suitable for your husband.
We send you and your husband our best wishes. Please let us know how he does, what other questions arise, and guidance you need. We are here to help any time.
Jason Sager, MD
