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What Causes Elevated Bilirubin Levels Post Chemotherapy And Radiation?
Question: I had an operation to remove my gall bladder and a portion of my bile duct about four months ago. There was a malignant tumor that was 2cms long in the bile duct but the surgeon was satisfied that he had a clear margin all around. There was evidence that cancer had grown on one of the nerves attached to the bile duct. subsequently I had five weeks of combination chemotherapy and radiation to clear out any cells that had got loose around the bile duct.
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My total bilirubin has been stable at 0.6 or 0.7 since shortly after the operation. About five days ago it suddenly went up to 1.5 (in the course of a week). The next day it was at 1.2, two days later it was at 0.9, two days later (yesterday) it was at 1.0. On the day that it was at 1.5 there was also a trace of bilirubin in my urine.
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My obvious concern is that the cancer is growing back and is partially obstructing the remains of the bile duct causing my total bilirubin to rise. My primary care physician says that an obstruction would cause a much stronger effect, and my Father (who is a primary care physician) says that he thinks it is too soon for the cancer to have grown back.
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Is it too soon to worry about this? Are there alternative explanations?
.
My total bilirubin has been stable at 0.6 or 0.7 since shortly after the operation. About five days ago it suddenly went up to 1.5 (in the course of a week). The next day it was at 1.2, two days later it was at 0.9, two days later (yesterday) it was at 1.0. On the day that it was at 1.5 there was also a trace of bilirubin in my urine.
.
My obvious concern is that the cancer is growing back and is partially obstructing the remains of the bile duct causing my total bilirubin to rise. My primary care physician says that an obstruction would cause a much stronger effect, and my Father (who is a primary care physician) says that he thinks it is too soon for the cancer to have grown back.
.
Is it too soon to worry about this? Are there alternative explanations?
Brief Answer:
it might be only physiological. do not worry
Detailed Answer:
Hello,
Thanks for posting in HCM.
I assume bilirubin values are measured as mg/dl. Accordingly the usual maximum limit of total bilirubin is 1.2 to 1.4 in males.
You have mentioned the values have been fluctuating as 1.5 then 1.2 then 0.9 and 1.0. So if you see the pattern here it is not gradually rising or steadily increasing.
It is just physiological in any human body. The changes are related to diet - if someday you had more of fatty or meat in diet it will go up. And as your gall bladder is removed there is no storage of bile to release which usually gets released as response to fatty meal or meaty meal.
So liver has to produce bile and just keep on secreting bile until the work of digestion is done. So it might go bit higher and again come down as has happened in your situation.
I do not feel it is recurrence of any cancer because the pattern is declining and back to normal range.
You can keep a check on your bilirubin levels for mental satisfaction. But I would order the test every 15 days or a month. You may follow this frequency or as per your doctor's instruction. Don't do it daily or very frequently as it will go up and down.
I wouldn't be concerned here. I feel its totally physiological and nothing to be worried about.
I hope I have answered your query well. If you have any questions kindly ask me back.
Thank you
it might be only physiological. do not worry
Detailed Answer:
Hello,
Thanks for posting in HCM.
I assume bilirubin values are measured as mg/dl. Accordingly the usual maximum limit of total bilirubin is 1.2 to 1.4 in males.
You have mentioned the values have been fluctuating as 1.5 then 1.2 then 0.9 and 1.0. So if you see the pattern here it is not gradually rising or steadily increasing.
It is just physiological in any human body. The changes are related to diet - if someday you had more of fatty or meat in diet it will go up. And as your gall bladder is removed there is no storage of bile to release which usually gets released as response to fatty meal or meaty meal.
So liver has to produce bile and just keep on secreting bile until the work of digestion is done. So it might go bit higher and again come down as has happened in your situation.
I do not feel it is recurrence of any cancer because the pattern is declining and back to normal range.
You can keep a check on your bilirubin levels for mental satisfaction. But I would order the test every 15 days or a month. You may follow this frequency or as per your doctor's instruction. Don't do it daily or very frequently as it will go up and down.
I wouldn't be concerned here. I feel its totally physiological and nothing to be worried about.
I hope I have answered your query well. If you have any questions kindly ask me back.
Thank you
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Above answer was peer-reviewed by :
Dr. Prasad
Answered by
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