One of the major sites of tumor spread of colon cancer spread is the liver.
The liver can compensate for a long time despite having large tumors. This is reason that our blood tests of liver function remain normal despite the liver having multiple lesions. However, if the tumors grow to a certain size or interfere with the bile ducts, they can cause the liver enzymes. including the bilirubin, to increase. When bilirubin increases patients develop jaundice, indicating that the liver is not functioning well.
This may have significant implications for treatment recommendations. Since most of the chemotherapeutic drugs are detoxified in the liver, many of them can not be safely be given in patients with increased bilirubin or liver enzymes. Irinotecan can not be given safely if the bilirubin is increased. Also Xeloda doses needs to be modified. However, 5-FU, oxaliplatin and both antibodies Erbitux and Avastin can be given despite high liver enzymes or bilirubin since they are not metabolized in the liver.
However liver enzyme levels are always criteria for clinical trials. Treatment with new agents is limited for patients who have had tumor progression after receiving all standard of care therapies. The National Institutes of Health has created an organ dysfunction working group, which USC is part of, which offers new drugs to patients with different degrees of liver dysfunction. Some of these drugs have shown some benefit for these patients.
Please. if you have problems with your liver function which means you are not eligible for clinical trials, contact your cancer center or NIH for sites which offer these organ dysfunction trials.
In my practice we have seen patients not treated because of their liver enzymes. Treatment was delayed to wait until the enzymes decreased, but in many cases this will not happen because increased enzymes are due to the cancer. In these patients, chemotherapy can be safely given.
I had an interesting patients years ago, with bile duct cancer. His bilirubin was 20 (very jaundiced). Usually doctors give up on these patients and refer to hospice. I treated him with oxaliplatin and 5-Fu with the full doses. He recovered within months and was able to live for more than a year, saw his first grandchild be born, and passed away 13 months later.
Please discuss it with your oncologist if there are any issues of chemotherapy and liver dysfunction, particular if treatment is held for it.
April 01, 2009 at 8:23 am, Concernedgal said:
I was very interested to read this.
My brother is in hospital today to have stents put in place as he has jaundice which may be caused by blocked liver ducts. Doctors said it may not work and the cancer itself may be causing jaundice rather than blocked bile ducts.
He has only had 1 cycle of Folfiri with Erbitux and was unable to have 2nd cycle due to jaundice.My brother would like me to meet his oncologist to disuss this post which has been most helpful
April 01, 2009 at 1:16 pm, Heinz-Josef Lenz said:
glad you found the blog helpful and more pleased that you are able to discuss this with your oncologists. HJL
April 28, 2009 at 12:40 pm, Concernedgal said:
Unfortunately we didnt get a chance to ask the oncologist as the stents did not work and he was too weak anyway for chemotherapy.
My brother passed away 2 weeks later. I understand you are a very busy man but have you came across anyone as young as 32 years and passed 11 weeks after diagnosis? Seems to have baffled our own doctors and hate how chemo never worked.
Many thanks
April 28, 2009 at 1:00 pm, Heinz-Josef Lenz said:
yes we have our youngest in the adult clinic was 18 years in childrens hopsital we have seen a 13 year old with metastatic disease……however 11 weeks is very short sorry to hear HJL
April 19, 2010 at 1:22 pm, james h phillips. said:
Is there any tx or news for the edema his bili.is 23.83 what can we do to help with this problem.he is 46 yr.old.diag. when he was 42 has had all the tx . he can take plus surg.