Jaundice, characterized by a yellowish discoloration of the skin and the whites of the eyes, occurs when there is an excess buildup of bilirubin in the bloodstream. Bilirubin is a yellow pigment formed during the normal breakdown of red blood cells. Pancreatic cancer often leads to jaundice, a common symptom. This article explains why.
The Pancreas, Bile, and Their Connection
The pancreas is an organ located deep in the abdomen, behind the stomach. It performs functions in both the digestive and endocrine systems. For digestion, the pancreas produces digestive enzymes that flow through small ducts into the main pancreatic duct. These enzymes help break down carbohydrates, proteins, and fats in food as it enters the small intestine.
Bile, a greenish-brown fluid, is produced by the liver and stored in the gallbladder. Its role is to aid in the digestion and absorption of fats in the small intestine. Bile travels from the liver and gallbladder through bile ducts, eventually reaching the common bile duct. The common bile duct then joins with the main pancreatic duct to form a single channel called the ampulla of Vater, which empties into the first part of the small intestine, the duodenum.
How Pancreatic Cancer Leads to Bile Duct Obstruction
Tumors that develop in the head of the pancreas, the widest part of the organ nestled within the curve of the duodenum, are particularly prone to causing this symptom. The common bile duct passes directly through or alongside the head of the pancreas on its way to the small intestine.
As a tumor in the head of the pancreas grows, it can physically press on or infiltrate the nearby common bile duct. This compression or invasion creates a blockage, preventing the normal flow of bile from the liver and gallbladder into the duodenum. When bile cannot drain properly, it backs up, first into the bile ducts within the liver, and then into the liver itself.
The backed-up bile, containing bilirubin, then spills into the bloodstream, causing the yellowing of skin and eyes associated with jaundice. Therefore, it is the tumor’s specific location and its mechanical obstruction of the bile duct that directly leads to jaundice in many pancreatic cancer patients.
Recognizing Jaundice: Signs and Symptoms
The most noticeable sign of jaundice is yellowing of the skin, which can range from pale to orange. The whites of the eyes (sclera) often show yellowing first. This discoloration results from bilirubin accumulating in tissues.
Other symptoms arise from bile duct obstruction and bilirubin buildup. Urine may appear dark, like tea or cola, as kidneys try to excrete excess bilirubin. Stools can become pale or clay-colored, as bile pigments are prevented from reaching the intestines. Many also experience generalized itching (pruritus), caused by bile salts in the skin.
Managing Jaundice in Pancreatic Cancer
Relieving jaundice in pancreatic cancer aims to restore the flow of bile.
One common intervention is endoscopic retrograde cholangiopancreatography (ERCP). During an ERCP, a flexible tube with a camera is guided through the mouth, stomach, and into the small intestine to reach the blocked bile duct. A small tube called a stent, made of plastic or metal, can then be placed into the narrowed or blocked bile duct to hold it open and allow bile to drain.
Another approach for bile drainage is percutaneous transhepatic biliary drainage (PTBD). This procedure involves inserting a thin needle through the skin and liver directly into a bile duct, allowing for external drainage of bile into a collection bag. While stents are often the first choice, PTBD can be an alternative, especially if ERCP is not feasible or successful.
In some cases, surgical options can also alleviate the obstruction. Biliary bypass surgery, such as a choledochojejunostomy, involves rerouting the bile flow by connecting the bile duct above the blockage directly to a section of the small intestine. For patients whose cancer is localized and removable, a pancreaticoduodenectomy, also known as the Whipple procedure, involves removing the head of the pancreas along with parts of the bile duct, gallbladder, and small intestine, thereby addressing the tumor and the obstruction simultaneously. The choice of intervention depends on the patient’s overall health and the cancer’s stage.