Cholangiocarcinoma, Cholangiocarcinoma of Biliary Tract, Cholangiocellular Carcinoma
Bile duct cancer is rare. It can happen in the parts of the bile ducts that are outside or inside the liver. Risk factors include bile duct inflammation, ulcerative colitis, and certain liver diseases. Explore tests, diagnosis, treatment options, and survival rates associated with bile duct cancer.
Bile Duct , Pancreas and Duodenum
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Bile Duct Cancer
Normal Gallbladder and Bile Duct
Image by TheVisualMD
Normal Gallbladder and Bile Duct
Normal Gallbladder, A pear-shaped organ just below the liver that stores the bile secreted by the liver. During a fatty meal, the gallbladder contracts, delivering the bile through the bile ducts into the intestines to help with digestion.
Image by TheVisualMD
Bile Duct Cancer
Your liver makes a digestive juice called bile. Your gallbladder stores it between meals. When you eat, your gallbladder pushes the bile into tubes called bile ducts. They carry the bile to your small intestine. The bile helps break down fat. It also helps the liver get rid of toxins and wastes.
Bile duct cancer is rare. It can happen in the parts of the bile ducts that are outside or inside the liver. Cancer of the bile duct outside of the liver is much more common. Risk factors include having inflammation of the bile duct, ulcerative colitis, and some liver diseases.
Symptoms can include
Jaundice
Itchy skin
Fever
Abdominal pain
Tests to diagnose bile duct cancer may include a physical exam, imaging tests of the liver and bile ducts, blood tests, and a biopsy.
Treatments include surgery, radiation therapy, and chemotherapy.
Source: National Cancer Institute (NCI)
Additional Materials (8)
Bile Duct Cancer
ERC: stents placed in the left and right bile duct. At the right, the contrast that has been given before is already well-drained, making the bile ducts clearly recognizable due to the intruding air.
Image by Hellerhoff
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Bile Duct Cancer
Cholangiocarcinoma : Photograph of cholangiocarcinoma in human liver from a patient. Cholangiocarcinoma is a form of cancer that is composed of mutated epithelial cells (or cells showing characteristics of epithelial differentiation) that originate in the bile ducts which drain bile from the liver into the small intestine. Other biliary tract cancers include pancreatic cancer, gallbladder cancer, and cancer of the ampulla of Vater.
Image by Fidel22
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The photographs underneath the schematic show two livers with advanced CCA.
The photographs underneath the schematic show two livers with advanced CCA.
Image by Sripa B, Kaewkes S, Sithithaworn P, Mairiang E, Laha T, et al./Wikimedia
Bile Pathway
Bile plays a significant role in the intestinal absorption of fats. Bile is produced in the liver and stored in the gallbladder. It is excreted into the intestines via a duct that travels through the pancreas before emptying into the duodenum (small intestine).
Our Stories: A Second Opinion Saves the Life of a Patient with Bile Duct Cancer
UCSFMedicalCenter/YouTube
2:58
Detection of Bile Duct and Pancreatic Cancers Doubles With New Tests
Mayo Clinic/YouTube
9:28
Bile duct cancer: Mayo Clinic Radio
Mayo Clinic/YouTube
Overview
Common Bile Duct and Pancreatic Duct Entering Duodenum
Image by TheVisualMD
Common Bile Duct and Pancreatic Duct Entering Duodenum
The pancreas functions as two organs in one. It secretes digestive enzymes into the duodenum (the first section of the small intestine), which then combine with bile, produced in the liver and stored in the gallbladder. The majority of cells in the pancreas (some 98%) are cells arranged in grapelike clusters that produce these important enzymes. The other 2% of pancreatic cells are those that produce the hormone insulin. Our bodies (and especially our brains) run on glucose, which is produced by the digestion of carbohydrates. The body's ability to use glucose as its main source of energy depends on insulin.
Image by TheVisualMD
General Information About Bile Duct Cancer
General Information About Bile Duct Cancer
KEY POINTS
Bile duct cancer is a rare disease in which malignant (cancer) cells form in the bile ducts.
Having colitis or certain liver diseases can increase the risk of bile duct cancer.
Signs of bile duct cancer include jaundice and pain in the abdomen.
Tests that examine the bile ducts and nearby organs are used to diagnose and stage bile duct cancer.
Different procedures may be used to obtain a sample of tissue and diagnose bile duct cancer.
Certain factors affect prognosis (chance of recovery) and treatment options.
Bile duct cancer is a rare disease in which malignant (cancer) cells form in the bile ducts.
A network of tubes, called ducts, connects the liver, gallbladder, and small intestine. This network begins in the liver where many small ducts collect bile (a fluid made by the liver to break down fats during digestion). The small ducts come together to form the right and left hepatic ducts, which lead out of the liver. The two ducts join outside the liver and form the common hepatic duct. The cystic duct connects the gallbladder to the common hepatic duct. Bile from the liver passes through the hepatic ducts, common hepatic duct, and cystic duct and is stored in the gallbladder.
When food is being digested, bile stored in the gallbladder is released and passes through the cystic duct to the common bile duct and into the small intestine.
Bile duct cancer is also called cholangiocarcinoma.
There are two types of bile duct cancer:
Intrahepatic bile duct cancer: This type of cancer forms in the bile ducts inside the liver. Only a small number of bile duct cancers are intrahepatic. Intrahepatic bile duct cancers are also called intrahepatic cholangiocarcinomas.Anatomy of the intrahepatic bile ducts. Intrahepatic bile ducts are a network of small tubes that carry bile inside the liver. The smallest ducts, called ductules, come together to form the right hepatic bile duct and the left hepatic bile duct, which drain bile from the liver. Bile is stored in the gallbladder and is released when food is being digested.
Extrahepatic bile duct cancer: The extrahepatic bile duct is made up of the hilum region and the distal region. Cancer can form in either region:
Perihilar bile duct cancer: This type of cancer is found in the hilum region, the area where the right and left bile ducts exit the liver and join to form the common hepatic duct. Perihilar bile duct cancer is also called a Klatskin tumor or perihilar cholangiocarcinoma.
Distal extrahepatic bile duct cancer: This type of cancer is found in the distal region. The distal region is made up of the common bile duct which passes through the pancreas and ends in the small intestine. Distal extrahepatic bile duct cancer is also called extrahepatic cholangiocarcinoma.
Anatomy of the extrahepatic bile ducts. Extrahepatic bile ducts are small tubes that carry bile outside of the liver. They are made up of the common hepatic duct (hilum region) and the common bile duct (distal region). Bile is made in the liver and flows through the common hepatic duct and the cystic duct to the gallbladder, where it is stored. Bile is released from the gallbladder when food is being digested.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the following:
Whether the cancer is in the upper or lower part of the bile duct system.
The stage of the cancer (whether it affects only the bile ducts or has spread tothe liver, lymph nodes, or other places in the body).
Whether the cancer has spread to nearby nerves or veins.
Whether the cancer can be completely removed by surgery.
Whether the patient has other conditions, such as primary sclerosing cholangitis.
Whether the level of CA 19-9 is higher than normal.
Whether the cancer has just been diagnosed or has recurred (come back).
Treatment options may also depend on the symptoms caused by the cancer. Bile duct cancer is usually found after it has spread and can rarely be completely removed by surgery. Palliative therapy may relieve symptoms and improve the patient's quality of life.
Source: National Cancer Institute (NCI)
Additional Materials (5)
Diagram showing the position of the perihilar bile ducts
Perihilar bile duct cancer develops just outside the liver. The stage of a cancer tells you its size and whether it has spread. Your doctor looks at your scans and x-rays to work out the stage. This helps them to decide what treatment you need.
Image by Wikimedia/Cancer Research UK
ERCP image of cholangiocarcinoma, showing common bile duct stricture and dilation of the proximal common bile duct
ERCP image of cholangiocarcinoma, showing common bile duct stricture and dilation of the proximal common bile duct
Image by Samir
Bile Duct Cancer: A patient's journey
Video by Dana-Farber Cancer Institute/YouTube
Bile Duct Cancer
Video by Medindia Videos/YouTube
Bile Duct Cancer: Klatskin Tumors
Video by Mark Fraiman, MD - St Joseph Medical Center Liver and Pancreas Center/YouTube
Diagram showing the position of the perihilar bile ducts
Wikimedia/Cancer Research UK
ERCP image of cholangiocarcinoma, showing common bile duct stricture and dilation of the proximal common bile duct
Samir
2:25
Bile Duct Cancer: A patient's journey
Dana-Farber Cancer Institute/YouTube
2:05
Bile Duct Cancer
Medindia Videos/YouTube
13:07
Bile Duct Cancer: Klatskin Tumors
Mark Fraiman, MD - St Joseph Medical Center Liver and Pancreas Center/YouTube
Risks
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Type 1 Perihilar Bile Duct Cancer
Image by Wikimedia/Cancer Research UK
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Type 1 Perihilar Bile Duct Cancer
The Bismuth-Corlette staging system divides perihilar cancers into 4 main types. The type you have depends on where the cancer is in the perihilar area.
Type 1 – the cancer is in the hepatic duct.
Image by Wikimedia/Cancer Research UK
Having Colitis or Certain Liver Diseases Can Increase the Risk of Bile Duct Cancer.
Having colitis or certain liver diseases can increase the risk of bile duct cancer.
Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor.
Risk factors for bile duct cancer include the following conditions:
Primary sclerosing cholangitis (a progressive disease in which the bile ducts become blocked by inflammation and scarring).
Chronic ulcerative colitis.
Cysts in the bile ducts (cysts block the flow of bile and can cause swollen bile ducts, inflammation, and infection).
Infection with a Chinese liver fluke parasite.
Source: National Cancer Institute (NCI)
Additional Materials (8)
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Bile Duct Cancer
Cholangiocarcinoma : Photograph of cholangiocarcinoma in human liver from a patient. Cholangiocarcinoma is a form of cancer that is composed of mutated epithelial cells (or cells showing characteristics of epithelial differentiation) that originate in the bile ducts which drain bile from the liver into the small intestine. Other biliary tract cancers include pancreatic cancer, gallbladder cancer, and cancer of the ampulla of Vater.
Life cycle of Clonorchis sinensis, a liver fluke associated with cholangiocarcinoma
Clonorchiasis [Clonorchis sinensis]
Causal Agent:
The trematode Clonorchis sinensis (Chinese or oriental liver fluke).
Life Cycle:
Life cycle of Clonorchis sinensis
Embryonated eggs are discharged in the biliary ducts and in the stool . Eggs are ingested by a suitable snail intermediate host ; there are more than 100 species of snails that can serve as intermediate hosts. Each egg releases a miracidia , which go through several developmental stages (sporocysts , rediae , and cercariae ). The cercariae are released from the snail and after a short period of free-swimming time in water, they come in contact and penetrate the flesh of freshwater fish, where they encyst as metacercariae . Infection of humans occurs by ingestion of undercooked, salted, pickled, or smoked freshwater fish . After ingestion, the metacercariae excyst in the duodenum and ascend the biliary tract through the ampulla of Vater . Maturation takes approximately 1 month. The adult flukes (measuring 10 to 25 mm by 3 to 5 mm) reside in small and medium sized biliary ducts. In addition to humans, carnivorous animals can serve as reservoir hosts.
Geographic Distribution:
Endemic areas are in Asia including Korea, China, Taiwan, and Vietnam. Clonorchiasis has been reported in non endemic areas (including the United States). In such cases, the infection is found in Asian immigrants, or following ingestion of imported, undercooked or pickled freshwater fish containing metacercariae.
Image by CDC/Wikimedia
Cholangiocarcinoma - Mayo Clinic
Video by Mayo Clinic/YouTube
Ulcerative Colitis
Video by mdconversation/YouTube
What is Ulcerative Colitis?
Video by Animated IBD Patient/YouTube
Clonorchiasis
Parasite infection by raw fish is rare (less than 40 cases per year in the U.S.), but involves mainly three kinds of parasites: Clonorchis sinensis (a trematode/fluke), Anisakis (a nematode/roundworm) and Diphyllobothrium a (cestode/tapeworm), all with gastrointestinal, but otherwise distinct, symptoms.
Life cycle of Clonorchis sinensis, a liver fluke associated with cholangiocarcinoma
CDC/Wikimedia
5:06
Cholangiocarcinoma - Mayo Clinic
Mayo Clinic/YouTube
15:50
Ulcerative Colitis
mdconversation/YouTube
4:22
What is Ulcerative Colitis?
Animated IBD Patient/YouTube
Clonorchiasis
Mikael Haggstrom
Signs
Jaundice of the sclerotic
Image by Bobjgalindo/Wikimedia
Jaundice of the sclerotic
Jaundice of the sclerotic in a 60 year old male patient with a positive urine for Leptospira.
Image by Bobjgalindo/Wikimedia
Signs of Bile Duct Cancer Include Jaundice and Pain in the Abdomen.
Signs of bile duct cancer include jaundice and pain in the abdomen.
These and other signs and symptoms may be caused by bile duct cancer or by other conditions. Check with your doctor if you have any of the following:
Jaundice (yellowing of the skin or whites of the eyes).
Dark urine.
Clay colored stool.
Pain in the abdomen.
Fever.
Itchy skin.
Nausea and vomiting.
Weight loss for an unknown reason.
Source: National Cancer Institute (NCI)
Additional Materials (4)
Kelly’s Story | Liver Cancer Patient Testimonial
Video by Cleveland Clinic/YouTube
Center of Excellence: Liver and Bile Duct Cancer
Video by Mount Sinai Health System/YouTube
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Bile Duct Cancer
Cholangiocarcinoma : Photograph of cholangiocarcinoma in human liver from a patient. Cholangiocarcinoma is a form of cancer that is composed of mutated epithelial cells (or cells showing characteristics of epithelial differentiation) that originate in the bile ducts which drain bile from the liver into the small intestine. Other biliary tract cancers include pancreatic cancer, gallbladder cancer, and cancer of the ampulla of Vater.
Image by Banchob Sripa
CT scan showing cholangiocarcinoma.
CT scan showing cholangiocarcinoma.
Image by The original uploader was Samir at English Wikipedia./Wikimedia
2:03
Kelly’s Story | Liver Cancer Patient Testimonial
Cleveland Clinic/YouTube
5:55
Center of Excellence: Liver and Bile Duct Cancer
Mount Sinai Health System/YouTube
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Bile Duct Cancer
Banchob Sripa
CT scan showing cholangiocarcinoma.
The original uploader was Samir at English Wikipedia./Wikimedia
Diagnosis
Bile Duct Cancer
Image by Hellerhoff
Bile Duct Cancer
ERC: stents placed in the left and right bile duct. At the right, the contrast that has been given before is already well-drained, making the bile ducts clearly recognizable due to the intruding air.
Image by Hellerhoff
Tests That Examine the Bile Ducts and Nearby Organs Are Used to Detect (Find), Diagnose, and Stage Bile Duct C
Tests that examine the bile ducts and nearby organs are used to diagnose and stage bile duct cancer.
Procedures that make pictures of the bile ducts and the nearby area help diagnose bile duct cancer and show how far the cancer has spread. The process used to find out if cancer cells have spread within and around the bile ducts or to distant parts of the body is called staging.
In order to plan treatment, it is important to know if the bile duct cancer can be removed by surgery. Tests and procedures to detect, diagnose, and stage bile duct cancer are usually done at the same time.
The following tests and procedures may be used:
Physical exam and health history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
Liver function tests: A procedure in which a blood sample is checked to measure the amounts of bilirubin and alkaline phosphatase released into the blood by the liver. A higher than normal amount of these substances can be a sign of liver disease that may be caused by bile duct cancer.
Laboratory tests: Medical procedures that test samples of tissue, blood, urine, or other substances in the body. These tests help to diagnose disease, plan and check treatment, or monitor the disease over time.
Carcinoembryonic antigen (CEA) and CA 19-9 tumor marker test: A procedure in which a sample of blood, urine, or tissue is checked to measure the amounts of certain substances made by organs, tissues, or tumor cells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the body. These are called tumor markers. Higher than normal levels of carcinoembryonic antigen (CEA) and CA 19-9 may mean there is bile duct cancer.
Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs, such as the abdomen, and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.
CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the abdomen, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
MRCP (magnetic resonance cholangiopancreatography): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body such as the liver, bile ducts, gallbladder, pancreas, and pancreatic duct.
Different procedures may be used to obtain a sample of tissue and diagnose bile duct cancer.
Cells and tissues are removed during a biopsy so they can be viewed under a microscope by a pathologist to check for signs of cancer. Different procedures may be used to obtain the sample of cells and tissue. The type of procedure used depends on whether the patient is well enough to have surgery.
Types of biopsy procedures include the following:
Laparoscopy: A surgical procedure to look at the organs inside the abdomen, such as the bile ducts and liver, to check for signs of cancer. Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. Other instruments may be inserted through the same or other incisions to perform procedures such as taking tissue samples to be checked for signs of cancer.
Percutaneous transhepatic cholangiography (PTC): A procedure used to x-ray the liver and bile ducts. A thin needle is inserted through the skin below the ribs and into the liver. Dye is injected into the liver or bile ducts and an x-ray is taken. A sample of tissue is removed and checked for signs of cancer. If the bile duct is blocked, a thin, flexible tube called a stent may be left in the liver to drain bile into the small intestine or a collection bag outside the body. This procedure may be used when a patient cannot have surgery.
Endoscopic retrograde cholangiopancreatography (ERCP): A procedure used to x-ray the ducts (tubes) that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine. Sometimes bile duct cancer causes these ducts to narrow and block or slow the flow of bile, causing jaundice. An endoscope is passed through the mouth and stomach and into the small intestine. Dye is injected through the endoscope (thin, tube-like instrument with a light and a lens for viewing) into the bile ducts and an x-ray is taken. A sample of tissue is removed and checked for signs of cancer. If the bile duct is blocked, a thin tube may be inserted into the duct to unblock it. This tube (or stent) may be left in place to keep the duct open. This procedure may be used when a patient cannot have surgery.
Endoscopic ultrasound (EUS): A procedure in which an endoscope is inserted into the body, usually through the mouth or rectum. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. A sample of tissue is removed and checked for signs of cancer. This procedure is also called endosonography.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis and treatment options depend on the following:
Whether the cancer is in the upper or lower part of the bile duct system.
The stage of the cancer (whether it affects only the bile ducts or has spread to the liver, lymph nodes, or other places in the body).
Whether the cancer has spread to nearby nerves or veins.
Whether the cancer can be completely removed by surgery.
Whether the patient has other conditions, such as primary sclerosing cholangitis.
Whether the level of CA 19-9 is higher than normal.
Whether the cancer has just been diagnosed or has recurred (come back).
Treatment options may also depend on the symptoms caused by the cancer. Bile duct cancer is usually found after it has spread and can rarely be completely removed by surgery. Palliative therapy may relieve symptoms and improve the patient's quality of life.
Source: National Cancer Institute (NCI)
Additional Materials (3)
Magnetic resonance cholangiopancreatography (MRCP)
image of patient with two stones in distal en:common bile duct
Image by Samir
What your Liver Function Test results can show
Video by Pathology Tests Explained/YouTube
Interpretation of LFTs (Liver Function Tests)
Video by Strong Medicine/YouTube
Magnetic resonance cholangiopancreatography (MRCP)
Samir
3:39
What your Liver Function Test results can show
Pathology Tests Explained/YouTube
26:45
Interpretation of LFTs (Liver Function Tests)
Strong Medicine/YouTube
Liver Function Tests
Liver Function Tests
Also called: Liver Panel, Liver Function Panel, Liver Profile, Hepatic Function Panel
Liver function tests are blood tests that measure different enzymes, proteins, and other substances made by the liver. Abnormal levels of any of these substances can be a sign of liver disease.
Liver Function Tests
Also called: Liver Panel, Liver Function Panel, Liver Profile, Hepatic Function Panel
Liver function tests are blood tests that measure different enzymes, proteins, and other substances made by the liver. Abnormal levels of any of these substances can be a sign of liver disease.
Liver function tests (also called a liver panel) use a sample of your blood to measure several substances made by your liver.
The most common liver function tests measure:
Albumin, a protein made in the liver.
Total protein. This test measures the total amount of protein in your blood, which includes albumin and globulins. These proteins are mainly made in your liver.
ALP (alkaline phosphatase), ALT (alanine transaminase), AST (aspartate aminotransferase), and GGT (gamma-glutamyl transferase). These are enzymes that are mainly made in your liver. Enzymes are proteins that speed up certain chemical reactions in your body.
Bilirubin, a waste product your body makes when it breaks down old red blood cells. Your liver removes most of the bilirubin from your body.
Lactate dehydrogenase (LDH), an enzyme found in most of the tissues in your body, but some of the largest amounts are found in your liver.
Prothrombin time (PT), how long it takes your blood to clot. Prothrombin is a protein involved in blood clotting. It's made in your liver.
Some of these tests can show how well your liver is working and others can show whether your liver may be damaged by liver disease or injury. But liver function tests alone usually can't diagnose specific diseases. So, if your results are abnormal, you'll usually need other tests to find the exact cause.
Other names: liver panel, liver function panel, liver profile hepatic function panel, LFT
Liver function tests are most often used to help:
Find out if liver disease or damage could be causing certain symptoms
Learn how serious liver disease is after it has been diagnosed
Monitor liver disease over time and/or find out how well treatment is working
Check for side effects of certain medicines that can affect the liver
Many liver function tests are included in a common blood test called a comprehensive metabolic panel (CMP). Your provider often orders a CMP as part of your routine checkup to screen for liver and other diseases.
You may also need liver function tests if you have symptoms of liver disease or damage. These include:
Nausea and vomiting
Lack of appetite
Fatigue
Weakness
Jaundice, a condition that causes your skin and eyes to turn yellow
Even if you don't have symptoms, you may need to be tested if you have a high risk for liver damage. Your risk may be high if you have:
A family history of liver disease
Alcohol use disorder (AUD)
Obesity
Diabetes
Been taking certain medicines that may cause liver damage
Hepatitis or have been exposed to hepatitis (swelling of the liver from infection or injury)
If you already have liver disease, you may need to be tested to monitor your condition and/or to see how well your treatment is working.
A health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.
Your provider will tell you how to prepare for your test. You will probably need to fast (not eat or drink) for 10-12 hours before the test. Certain medicines can affect your test results, so be sure to tell your provider about everything you take. But don't stop taking any medicines unless your provider tells you to.
There is very little risk to having a blood test. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.
Understanding abnormal liver function test results is often complicated. So, it's best to ask your provider to explain what your results say about your health.
If any of your liver function test results are abnormal, your provider will compare the results of all the substances that were measured. This is done to look for certain patterns of normal and abnormal results that suggest different types of liver conditions.
In general, the results of your liver function tests can tell you if:
Your liver is inflamed, which means you have hepatitis.
You have hepatitis from drinking alcohol or other causes, such as infection.
Your liver isn't working well and how weak it has become.
You have a problem with your bile ducts. Bile is a digestive "juice" that your liver makes. Bile ducts are the tubes that carry bile through your liver and out of your liver.
Medicines are harming your liver and how serious the damage is.
Abnormal results don't always mean you have a problem with your liver. Other conditions can cause high or low levels of certain substances that these tests measure. For example, high levels of ALP can be a sign of bone disease or liver disease. So, your provider will also consider your symptoms, medical history, risk for liver disease, and any medicines you take.
If you have been ill recently, certain types of abnormal results may be temporary. In this case, your provider may repeat the tests later to see if your results return to normal.
Liver Function Tests: MedlinePlus [accessed on Dec 10, 2023]
Liver Biopsy and Liver Function Tests - Diagnosing Liver Disease [accessed on Jan 14, 2019]
Liver Function Tests: Purpose, Procedure, and Risk [accessed on Jan 14, 2019]
Additional Materials (16)
Healthy liver (left) versus alcoholic liver disease (right)
Image by TheVisualMD
Enlarged Liver, a Sign of Hemochromatosis
Enlarged Liver, a Sign of Hemochromatosis : Hemochromatosis is a genetic disease that causes the body to absorb too much iron. Because the body can't use or eliminate this extra iron, it's stored in organs, especially the liver, but also the heart and pancreas. Eventually, up to 20 times as much iron as normal can accumulate, which can lead to organ failure. Symptoms can include irregular heartbeat, cirrhosis, chronic fatigue, confusion, and hepatomegaly, the enlargement of the liver.
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Liver and Lipoproteins
Liver and Lipoproteins
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Female Digestive System Including Liver
Female Digestive System Including Liver
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Obesity is often a precursor to Fatty Liver Disease
Obesity is often a precursor to Fatty Liver Disease
Image by TheVisualMD
Drawing of a liver biopsy procedure
A liver is drawn within an outline of a male body. A needle pricks a piece of the liver tissue. An arrow points away from the spot where the needle touches the liver toward a slide with the tissue sample. The liver is labeled. In a liver biopsy, a doctor uses a needle to take a small piece of liver tissue to view with a microscope.
Image by NIDDK Image Library
Healthy liver (left) vs unhealthy, fatty liver (right)
Liver function is typically evaluated by a panel of tests, including one for alanine aminotransferase (ALT), an enzyme made in liver cells, that help doctors distinguish among the many different possible causes of liver damage. Alcoholic liver disease is linked to the length of time alcohol is consumed, as well as quantity, though not all heavy drinkers develop it; genetics and sex also play roles. Symptoms include liver inflammation, enlargement, and eventually scarring (cirrhosis).
Image by TheVisualMD
Liver
The liver is a vital organ that has a wide range of functions; a few of which are detoxification, protein synthesis and production of biochemicals necessary for digestion. It is the largest organ in the body and is critical to one's health. Some of the most common conditions involving damage to the liver include alcoholic liver disease, cirrhosis, and hepatitis. The liver's general role is in the body's metabolism, secreting hormones that moderate the storage and breakdown of sugar. Glucose is the body's form of energy gleaned from carbohydrates, and it is stored in body cells as glycogen until the liver determines it is needed. At this point, the liver secrets glucagon, a hormone that will signal to cells to convert glycogen into its usable form, glucose.
Image by TheVisualMD
What your Liver Function Test results can show
Video by Pathology Tests Explained/YouTube
Introduction to liver function tests
Video by Jaz Singh/YouTube
Liver Function Tests
Video by Rahul Patwari/YouTube
Understanding Blood Test Video 2: Comprehensive Metabolic Panel
Video by Health in a Nutshell/YouTube
LIVER FUNCTION TESTING! - AST, ALT, and ALP- Is your liver in SERIOUS TROUBLE?
In nonalcoholic fatty liver disease (NAFLD) fat accumulates in the liver cells. NAFLD is most often found in people who are middle-aged and overweight or obese. About half of all obese kids are also thought to have nonalcoholic fatty liver disease.
Interactive by TheVisualMD
Healthy liver (left) versus alcoholic liver disease (right)
TheVisualMD
Enlarged Liver, a Sign of Hemochromatosis
TheVisualMD
Liver and Lipoproteins
TheVisualMD
Sensitive content
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Female Digestive System Including Liver
TheVisualMD
Obesity is often a precursor to Fatty Liver Disease
TheVisualMD
Drawing of a liver biopsy procedure
NIDDK Image Library
Healthy liver (left) vs unhealthy, fatty liver (right)
TheVisualMD
Liver
TheVisualMD
3:39
What your Liver Function Test results can show
Pathology Tests Explained/YouTube
4:02
Introduction to liver function tests
Jaz Singh/YouTube
8:59
Liver Function Tests
Rahul Patwari/YouTube
5:17
Understanding Blood Test Video 2: Comprehensive Metabolic Panel
Health in a Nutshell/YouTube
13:29
LIVER FUNCTION TESTING! - AST, ALT, and ALP- Is your liver in SERIOUS TROUBLE?
Also called: Albumin, ALB, Hypoalbuminemia Test, Hyperalbuminemia Test
Albumin is a protein made by the liver that makes up about 60% of the total protein in the blood. An albumin blood test can help diagnose, evaluate, and monitor kidney and liver conditions.
Albumin Blood Test
Also called: Albumin, ALB, Hypoalbuminemia Test, Hyperalbuminemia Test
Albumin is a protein made by the liver that makes up about 60% of the total protein in the blood. An albumin blood test can help diagnose, evaluate, and monitor kidney and liver conditions.
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Use the slider below to see how your results affect your
health.
g/dL
3.5
5
Your result is Normal.
Albumin is the most abundant protein in the body. It is made by the liver and plays many important roles, including maintaining pressure in the blood vessels and transporting substances, such as hormones and medications.
Related conditions
An albumin blood test measures the amount of albumin in your blood. Low albumin levels can be a sign of liver or kidney disease or another medical condition. High levels may be a sign of dehydration.
Albumin is a protein made by your liver. Albumin enters your bloodstream and helps keep fluid from leaking out of your blood vessels into other tissues. It is also carries hormones, vitamins, and enzymes throughout your body. Without enough albumin, fluid can leak out of your blood and build up in your lungs, abdomen (belly), or other parts of your body.
An albumin blood test is used to check your general health and to see how well your liver and kidneys are working. If your liver is damaged or you're not well nourished, your liver may not make enough albumin. If your kidneys are damaged, they may let too much albumin leave your body in urine (pee).
An albumin blood test is often done as part of a group of blood tests that measure different enzymes, proteins, and other substances made in your liver. These tests are called liver function tests or liver panel. An albumin test may also be part of a comprehensive metabolic panel (CMP), a group of routine blood tests that measures several substances.
Your health care provider may order an albumin test as part your regular checkup. The test may be ordered as part of a group of liver function tests or a comprehensive metabolic panel. You may also need this test if you have symptoms of liver or kidney disease.
Symptoms of liver disease include:
Nausea and vomiting
Lack of appetite
Fatigue
Weakness
Jaundice, a condition that causes your skin and eyes to turn yellow
With some types of kidney disease, such as chronic kidney disease, you may not have symptoms until the later stages.
A health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.
You don't need any special preparations to test for albumin in blood. If your provider ordered other blood tests, you may need to fast (not eat or drink) for several hours before the test. Your provider will let you know if there are any special instructions to follow. Certain medicines may affect your test results, so tell your provider what you are taking. But don't stop taking any medicines without talking with your provider first.
There is very little risk to having a blood test. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.
An albumin blood test alone cannot diagnose a condition. Your provider will usually consider your albumin test results with the results of other tests to make a diagnosis.
Lower than normal albumin levels may be a sign of:
Liver disease, including severe cirrhosis, hepatitis, and fatty liver disease
Kidney disease
Malnutrition
Infection
Digestive diseases that involve problems using protein from food, such as Crohn's disease and malabsorption disorders
Burns over a large area of your body
Thyroid disease
Higher than normal albumin levels may be a sign of dehydration, which may be caused by severe diarrhea or other conditions.
If your albumin levels are not in the normal range, it doesn't always mean you have a medical condition that needs treatment. Certain medicines, including steroids, insulin, and hormones, can increase albumin levels. Not eating can cause a large decrease in albumin after 24 to 48 hours. Other medicines, including birth control pills, can lower your albumin levels. Albumin levels are lower during pregnancy.
Your provider can explain what your test results mean.
Albumin Blood Test: MedlinePlus Lab Test Information [accessed on Dec 20, 2023]
Albumin - blood (serum): MedlinePlus Medical Encyclopedia [accessed on Dec 20, 2023]
Albumin Blood Test - Testing.com. Nov 24, 2022 [accessed on Dec 20, 2023]
Additional Materials (8)
Healthy vs Damaged Kidney
A healthy kidney doesn’t let albumin pass into the urine. A damaged kidney lets some albumin pass into the urine.
Urine Test for Albumin
If you are at risk for kidney disease, your provider may check your urine for albumin.
Albumin is a protein found in your blood. A healthy kidney doesn’t let albumin pass into the urine. A damaged kidney lets some albumin pass into the urine. The less albumin in your urine, the better. Having albumin in the urine is called albuminuria.
A diagram showing a healthy kidney with albumin only found in blood, and a damaged kidney that has albumin in both blood and urine.
A healthy kidney doesn’t let albumin pass into the urine. A damaged kidney lets some albumin pass into the urine.
A health care provider can check for albumin in your urine in two ways:
Dipstick test for albumin. A provider uses a urine sample to look for albumin in your urine. You collect the urine sample in a container in a health care provider’s office or lab. For the test, a provider places a strip of chemically treated paper, called a dipstick, into the urine. The dipstick changes color if albumin is present in the urine.
Urine albumin-to-creatinine ratio (UACR). This test measures and compares the amount of albumin with the amount of creatinine in your urine sample. Providers use your UACR to estimate how much albumin would pass into your urine over 24 hours. A urine albumin result of
30 mg/g or less is normal
more than 30 mg/g may be a sign of kidney disease
If you have albumin in your urine, your provider may want you to repeat the urine test one or two more times to confirm the results. Talk with your provider about what your specific numbers mean for you.
If you have kidney disease, measuring the albumin in your urine helps your provider know which treatment is best for you. A urine albumin level that stays the same or goes down may mean that treatments are working.
Image by The National Institute of Diabetes and Digestive and Kidney Diseases/NIH
Albumin Nursing Considerations, Normal Range, Nursing Care, Lab Values Nursing
Video by NURSINGcom/YouTube
Important Liver Values Albumin, ALT, ALP & AST
Video by NKN/YouTube
Electrophoresis - concentration - Albumin
The albumins (formed from Latin: albumen \"(egg) white; dried egg white\") are a family of globular proteins, the most common of which is serum albumin. The albumin family consists of all proteins that are water-soluble, are moderately soluble in concentrated salt solutions, and experience heat denaturation. Albumins are commonly found in blood plasma, and are unique from other blood proteins in that they are not glycosylated. Substances containing albumins, such as egg white, are called albuminoids. A number of blood transport proteins are evolutionarily related, including serum albumin, alpha-fetoprotein, vitamin D-binding protein and afamin.
Image by TheVisualMD
Electrophoresis - total protein - Albumin
The albumins (formed from Latin: albumen \"(egg) white; dried egg white\") are a family of globular proteins, the most common of which is serum albumin. The albumin family consists of all proteins that are water-soluble, are moderately soluble in concentrated salt solutions, and experience heat denaturation. Albumins are commonly found in blood plasma, and are unique from other blood proteins in that they are not glycosylated. Substances containing albumins, such as egg white, are called albuminoids. A number of blood transport proteins are evolutionarily related, including serum albumin, alpha-fetoprotein, vitamin D-binding protein and afamin.
Image by TheVisualMD
Albumin, Kidney Disease
Proteins are normally filtered out of the blood and recycled by the kidneys, including the blood protein albumin, which is produced by the liver and helps maintain the fluid balance of blood as well as transport hormones, vitamins, and other substances throughout the body. When kidneys are diseased or damaged, however, their ability to filter out proteins is compromised, which allows proteins like albumin to then leak into urine.
Image by TheVisualMD
Albumin: Kidney Disease
Kidney disease can result in abnormal albumin levels because diseased or damaged kidneys are not able to effectively filter out and recycle albumin in the blood; instead, albumin leaks into the urine.
Image by TheVisualMD
Albumin: Blood Serum
The serum is the clear, liquid portion of the blood. There are two classes of proteins, albumin and globulin, found in the blood. Albumin is the most abundant protein; its main purpose is to keep fluid from leaking out of blood vessels.
Image by TheVisualMD
Healthy vs Damaged Kidney
The National Institute of Diabetes and Digestive and Kidney Diseases/NIH
3:51
Albumin Nursing Considerations, Normal Range, Nursing Care, Lab Values Nursing
NURSINGcom/YouTube
7:55
Important Liver Values Albumin, ALT, ALP & AST
NKN/YouTube
Electrophoresis - concentration - Albumin
TheVisualMD
Electrophoresis - total protein - Albumin
TheVisualMD
Albumin, Kidney Disease
TheVisualMD
Albumin: Kidney Disease
TheVisualMD
Albumin: Blood Serum
TheVisualMD
Total Protein
Total Protein and Albumin/Globulin (A/G) Ratio
Also called: TP and A/G Ratio, Hypoproteinemia Test, Hyperproteinemia Test
A total protein and albumin/globulin (A/G) ratio test measures total protein levels in your blood. The two major proteins are albumin and globulin. It also compares the amount of albumin to the amount of globulin. The results can show if you have liver or kidney disease.
Total Protein and Albumin/Globulin (A/G) Ratio
Also called: TP and A/G Ratio, Hypoproteinemia Test, Hyperproteinemia Test
A total protein and albumin/globulin (A/G) ratio test measures total protein levels in your blood. The two major proteins are albumin and globulin. It also compares the amount of albumin to the amount of globulin. The results can show if you have liver or kidney disease.
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Use the slider below to see how your results affect your
health.
g/dL
6
8
Your result is Normal.
Proteins are important building blocks of all cells and tissues; they are important for body growth and health. Total protein level may reflect your nutritional status, the presence of kidney or liver disease, as well as many other conditions.
Related conditions
{"label":"Albumin\/globulin ratio reference range","scale":"lin","step":0.1,"hideunits":false,"items":[{"flag":"abnormal","label":{"short":"Low","long":"Low","orientation":"horizontal"},"values":{"min":0,"max":1},"text":"A low A\/G ratio may be due to overproduction of globulins and\/or underproduction of albumins. This can be a sign of an autoimmune disorder, kidney or liver disease.","conditions":["Multiple myeloma","Autoimmune diseases","Liver disease","Cirrhosis","Kidney disease","Nephrotic syndrome","Bone marrow tumor"]},{"flag":"normal","label":{"short":"Normal","long":"Normal","orientation":"horizontal"},"values":{"min":1,"max":2.5},"text":"An imbalance of albumins to globulins ratio gives insight into your nutritional status and immune function. The normal range for albumin\/globulin ratio is approximately 1 to 2. That\u2019s because there\u2019s a bit more albumin than globulin in serum protein.","conditions":[]},{"flag":"abnormal","label":{"short":"High","long":"High","orientation":"horizontal"},"values":{"min":2.5,"max":5},"text":"A high A\/G ratio can be due to an overproduction of albumins and\/or underproduction of globulins. This can be a sign of disease in your liver, kidney, or intestines. It\u2019s also linked to low thyroid activity and leukemia.","conditions":["Genetic Deficiencies","Leukemia","Liver disease","Kidney disease","Bowel disease"]}],"units":[{"printSymbol":"g\/dL","code":"g\/dL","name":"gram per deciliter"}],"value":1.8}[{"abnormal":0},{"normal":0},{"abnormal":0}]
Use the slider below to see how your results affect your
health.
g/dL
1
2.5
Your result is Normal.
An imbalance of albumins to globulins ratio gives insight into your nutritional status and immune function. The normal range for albumin/globulin ratio is approximately 1 to 2. That’s because there’s a bit more albumin than globulin in serum protein.
Related conditions
A total protein and albumin/globulin (A/G) ratio test measures the total amount of protein in your blood. There are two major types of protein in the blood:
Albumin, which helps keep blood from leaking out of blood vessels. It also helps move hormones, medicines, vitamins, and other important substances throughout the body. Albumin is made in the liver.
Globulins, which help fight infection and move nutrients throughout the body. Some globulins are made by the liver. Others are made by the immune system.
The test also compares the amount of albumin in your blood to the amount of globulin. The comparison is called the albumin/globulin (A/G) ratio.
If your total protein levels or A/G ratio results are not normal, it can be a sign of a serious health problem.
A total protein and A/G ratio test is often included as part of a comprehensive metabolic panel, a test that measures proteins and other substances in the blood. It may also be used to help diagnose kidney disease, liver disease, or nutritional problems.
You may get this test as part of a comprehensive metabolic panel, which is often included in a routine checkup. You may also need this test if you have symptoms that indicate abnormal protein levels. These include:
Swelling in the feet, ankles, legs, and/or abdomen, which is caused by extra fluid in your tissues
Fatigue
Unexplained weight loss
Loss of appetite
Nausea and vomiting
Jaundice (yellowing of the skin or eyes). This is a common symptom of liver disease.
Blood in the urine, a common symptom of kidney disease
A health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.
You don't need any special preparations for a total protein and A/G ratio test.
There is very little risk to having a blood test. There may be slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.
Your results will show whether you have normal, low, or high total protein levels. They will also show if you have a normal, low, or high albumin to globulin (A/G) ratio.
If your total protein levels were low, it may mean you have one of the following conditions:
Liver disease
Kidney disease
Malnutrition, a condition in which your body does not get the calories, vitamins, and/or minerals needed for good health
A malabsorption syndrome, a type of disorder in which your small intestine can't absorb enough nutrients from food. Malabsorption syndromes include celiac disease and Crohn's disease.
If your total protein levels were high, it may mean you have one of the following conditions:
An infection such as HIV or viral hepatitis
Multiple myeloma, a type of blood cancer
If your A/G ratio was low, it may be caused by:
An autoimmune disease, such as lupus
Liver disease, including cirrhosis
Kidney disease
If your A/G ratio was high, it may be caused by:
Certain types of genetic disorders
Leukemia
If you have questions about your results, talk to your health care provider.
In addition to total protein levels, your provider may order a separate blood test for albumin and/or a test for globulins. The globulins test is called serum electrophoresis. It is a blood test that measures the levels of four different types of globulins.
These results may show the following:
Low albumin levels may be a sign of:
Liver disease, including cirrhosis
Kidney disease
Malnutrition
Thyroid disease
High albumin levels may be a sign of:
Severe dehydration
Diarrhea
Low globulin levels may be a sign of:
Liver disease
Kidney disease
High globulin levels may be a sign of:
Certain types of blood cancers, such as multiple myeloma, Hodgkin disease, or leukemia
Hemolytic anemia
An autoimmune disease, such as lupus or rheumatoid arthritis
Tuberculosis
Total Protein and Albumin/Globulin (A/G) Ratio : MedlinePlus Medical Test [accessed on Dec 20, 2023]
Total protein: MedlinePlus Medical Encyclopedia [accessed on Dec 20, 2023]
Total Protein and A/G Ratio - Health Encyclopedia - University of Rochester Medical Center [accessed on Dec 20, 2023]
Additional Materials (4)
Serum Total Protein: Protein
Serum protein levels can reflect nutritional status in cases of malnutrition or malabsorption, but a high-protein diet does not raise serum levels.
Image by TheVisualMD
Symptoms of CKD, Excess Renin
The kidneys produce the hormone renin, which helps to control blood pressure. High blood pressure can lead to edema, a swelling caused by excess fluid trapped in the body's tissues, most commonly noticed in the hands, arms, feet, ankles, and legs.
Image by TheVisualMD
Kidney with Visible Blood Vessel
This is a cross-section of the left kidney showing only its dense vasculature. Blood flows in through the renal artery, and continues through the segmental, lobar, arcuate, and interlobular arteries, ending up in the cortex of the kidneys, where the filtering process takes place in the glomerular capillaries.
Image by TheVisualMD
Serum Total Protein: Kidney
Abnormalities of serum protein most often indicate kidney or liver problems; serum protein levels often rise before other symptoms appear.
Image by TheVisualMD
Serum Total Protein: Protein
TheVisualMD
Symptoms of CKD, Excess Renin
TheVisualMD
Kidney with Visible Blood Vessel
TheVisualMD
Serum Total Protein: Kidney
TheVisualMD
ALP
Alkaline Phosphatase Test
Also called: ALP, ALK, PHOS, Alkp, ALK PHOS
Alkaline phosphatase (ALP) is an enzyme that can be found throughout the body, but it's most abundant in the liver and bone. The test measures the amount of ALP in the blood. It is used to diagnose liver damage or bone disorders.
Alkaline Phosphatase Test
Also called: ALP, ALK, PHOS, Alkp, ALK PHOS
Alkaline phosphatase (ALP) is an enzyme that can be found throughout the body, but it's most abundant in the liver and bone. The test measures the amount of ALP in the blood. It is used to diagnose liver damage or bone disorders.
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Use the slider below to see how your results affect your
health.
U/L
44
147
Your result is Normal.
ALP is an enzyme found throughout the body, but it is mostly found in the liver, bones, kidneys, and digestive system. When ALP leaks into the bloodstream it may be a sign of a serious health issue.
Related conditions
An alkaline phosphatase (ALP) test measures the amount of ALP in your blood. ALP is an enzyme found in many parts of your body. Each part of your body produces a different type of ALP. Most ALP is found in your liver, bones, kidneys, and digestive system.
Abnormal levels of ALP in your blood may be a sign of a wide range of health conditions, including liver disease, bone disorders, and chronic kidney disease. But an alkaline phosphatase test alone can't identify the source of ALP in your blood, so other tests are usually needed to make a diagnosis.
An alkaline phosphatase test is often used to screen for or help diagnose diseases of the liver or bones. The test may also help diagnose or monitor other health conditions.
Your health care provider may order an alkaline phosphatase test as part of a routine checkup. Many conditions may affect ALP levels, so the test is often done with other blood tests. These other tests include a comprehensive metabolic panel (CMP) or liver function tests that check how well your liver is working.
An alkaline phosphatase test may also be ordered if you have symptoms of liver damage or a bone disorder. Symptoms of liver disease include:
Nausea and vomiting
Lack of appetite
Fatigue
Weakness
Jaundice, a condition that causes your skin and eyes to turn yellow
An alkaline phosphatase test is a type of blood test. During the test, a health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.
Preparations for an alkaline phosphatase test depend on the lab doing the test. Some labs require you to fast (not eat or drink) for 6 to 12 hours before the test. Also, the ALP test is usually ordered with other blood tests. You usually need to fast for several hours before these tests. Your provider will let you know if there are any special instructions to follow.
There is very little risk to having a blood test. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.
High alkaline phosphatase (ALP) levels may be a sign of a liver problem or a bone disorder. Liver problems and bone disorders cause different types of ALP. But your test results can't tell which type of ALP is high.
If your test results show high ALP levels, your provider may order other tests to help figure out what's causing the problem. These tests may include:
An ALP isoenzyme test. This test can tell which part of your body is making the ALP. But this test may not available everywhere.
Liver function tests. If the results of these tests are also high, then your high ALP level is likely from a problem in your liver.
High alkaline phosphatase levels from your liver may be a sign of:
Blockages in the bile ducts
Cirrhosis
Hepatitis
Mononucleosis, which can sometimes cause swelling in the liver
If alkaline phosphatase levels are high and the results of liver tests are normal, the problem may be a bone disorder, such as Paget's disease of bone. This disease makes your bones unusually large and weak, causing them to break more easily.
Moderately high levels of ALP may be a sign of a many different types of conditions, including Hodgkin lymphoma, heart failure, or certain infections.
It's possible to have higher than normal levels of ALP and not have a medical condition that needs treatment. Your provider will consider your symptoms, medical history, and other test results to make a diagnosis.
Low levels of ALP are less common. They may be a sign of a lack of zinc, malnutrition, pernicious anemia, thyroid disease, Wilson disease or hypophosphatasia, a rare genetic disease that affects bones and teeth.
Many things can affect ALP levels. Pregnancy can cause higher than normal ALP levels. Children and teens may have high levels of ALP because their bones are growing. Birth control pills and certain medicines may lower ALP levels, while other medicines can cause the levels to increase. Even eating a fatty meal before an alkaline phosphatase test may also cause a small increase in ALP.
To learn what your results mean, talk with your provider.
Alkaline Phosphatase: MedlinePlus Medical Test [accessed on Dec 20, 2023]
ALP - blood test: MedlinePlus Medical Encyclopedia [accessed on Dec 20, 2023]
Additional Materials (5)
Alkaline Phosphatase Nursing Considerations, Normal Range, Nursing Care, Lab Values Nursing
Video by NURSINGcom/YouTube
Alkaline Phosphatase Test
Alkaline phosphatase (ALP) is an enzyme made in liver cells. Elevated levels of ALP can be caused by many types of liver damage, including hepatitis, cirrhosis, liver cancer or drug toxicity. Heart bypass surgery or blood transfusions can cause temporary drops in ALP; persistently low levels of ALP may be caused by zinc deficiency or a rare genetic bone disorder.
Image by TheVisualMD
Alkaline Phosphatase, Liver
The liver is the body's central chemical plant, filtering blood and removing toxins, storing sugars, lipids, and vitamins, and producing important blood proteins. Liver function is typically evaluated by a panel of tests, including one for alkaline phosphatase (ALP), an enzyme made in liver cells, that help doctors distinguish among the many different possible causes of liver damage. Many types of liver damage, including hepatitis, cirrhosis, liver cancer or drug toxicity, can elevate ALP levels.
Image by TheVisualMD
Bilirubin, Gallbladder
When damaged or dying red blood cells are broken down, bilirubin, a yellow pigment and component of hemoglobin, is released into the bloodstream. Bilirubin is eliminated from the body by the liver as a component of bile, which is stored in the gallbladder and then released into the small intestine to aid digestion.
Image by TheVisualMD
Alkaline Phosphatase Test for Bone Growth
In bone, alkaline phosphatase (ALP) is produced by the cells (called osteoblasts) that are responsible for bone formation, which is why the test can be used to diagnose Paget's disease or detect cancers that have spread to the bone, both of which raise ALP blood levels. Alkaline phosphatase (ALP) is an enzyme made in liver cells. Children and adolescents normally have higher blood ALP levels because their bones are still growing and levels of the enzyme can spike during growth spurts. Fetal bone growth is the reason that pregnancy can elevate ALP blood levels, particularly in the 3rd trimester.
Image by TheVisualMD
3:25
Alkaline Phosphatase Nursing Considerations, Normal Range, Nursing Care, Lab Values Nursing
NURSINGcom/YouTube
Alkaline Phosphatase Test
TheVisualMD
Alkaline Phosphatase, Liver
TheVisualMD
Bilirubin, Gallbladder
TheVisualMD
Alkaline Phosphatase Test for Bone Growth
TheVisualMD
ALT
Alanine Transaminase Test
Also called: ALT, Alanine Aminotransferase, ALT Blood Test, Serum Glutamic-Pyruvic Transaminase, SGPT
Alanine transaminase (ALT) is an enzyme that can be found throughout the body, especially in the liver. When your liver is damaged, this enzyme gets released; therefore, an ALT test can be used to help diagnose liver disorders.
Alanine Transaminase Test
Also called: ALT, Alanine Aminotransferase, ALT Blood Test, Serum Glutamic-Pyruvic Transaminase, SGPT
Alanine transaminase (ALT) is an enzyme that can be found throughout the body, especially in the liver. When your liver is damaged, this enzyme gets released; therefore, an ALT test can be used to help diagnose liver disorders.
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Use the slider below to see how your results affect your
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300
Your result is Normal.
ALT, or alanine aminotransferase, is one of the two liver enzymes. It is a protein made only by liver cells. When ALT leaks out into the bloodstream it indicates that liver cells are damaged.
Related conditions
ALT stands for alanine transaminase. It is an enzyme found mostly in the liver. An ALT test measures the amount of ALT in the blood.
When liver cells are damaged, they release ALT into the bloodstream. High levels of ALT in your blood may be a sign of a liver injury or disease. Some types of liver disease cause high ALT levels before you have symptoms of the disease. So, an ALT blood test may help diagnose certain liver diseases early.
An ALT blood test is often part of a routine blood screening to check the health of your liver. The test may also help diagnose or monitor liver problems.
Your health care provider may order an ALT blood test, as part of a routine checkup. An ALT test is usually done with a group of other liver function tests that check how well your liver is working. These tests may also be ordered if you have symptoms of liver damage, such as:
Nausea and vomiting
Lack of appetite
Fatigue
Weakness
Jaundice, a condition that causes your skin and eyes to turn yellow
Your provider may also order an ALT blood test if you have a high risk for liver damage because of:
A family history of liver disease
Alcohol abuse disorder (AUD)
Obesity
Diabetes
Taking certain medicines that can cause liver damage
Hepatitis or exposure to hepatitis
A health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.
You don't need any special preparations for an ALT blood test. But an ALT test is usually ordered with other blood tests. You usually need to fast (not eat or drink) for several hours before these tests. Your provider will let you know if there are any special instructions to follow.
There is very little risk to having a blood test. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.
An ALT blood test is often done as part of a group of liver function tests. Liver function tests measure several different proteins, substances, and enzymes that show how well your liver is working. Your provider usually compares your ALT results with the results of the other liver tests to evaluate your liver health and to decide if you need other tests to make a diagnosis.
In general, high levels of ALT may be a sign of liver damage from hepatitis, infection, cirrhosis, liver cancer, or other liver diseases. The damage may also be from a lack of blood flow to the liver or certain medicines or poisons.
If your results show you have a high level of ALT, it doesn't always mean that you have a medical condition that needs treatment. Many things can affect your results, such as your age, sex, certain medicines and dietary supplements, intense exercise, how much you weigh, and having a menstrual period.
To learn what your results mean, talk with your provider. And be sure tell your provider about all the medicines and supplements you take.
ALT test results may help tell the difference between damage from acute (sudden) liver problems and chronic (long-term) liver problems. But the amount of ALT in your blood isn't related to how much your liver may be damaged.
ALT used to be called SGPT, which stands for serum glutamic-pyruvic transaminase. The ALT blood test was formerly known as the SGPT test.
ALT Blood Test: MedlinePlus Lab Test Information [accessed on Dec 20, 2023]
Alanine transaminase (ALT) blood test: MedlinePlus Medical Encyclopedia [accessed on Dec 20, 2023]
ALT: Liver Function Test - Viral Hepatitis and Liver Disease [accessed on Dec 20, 2023]
Additional Materials (5)
Alanine Aminotransferase (ALT): Liver lobule
The liver produce key proteins such as albumin and those involved in blood clotting, as well as half of the body's cholesterol (food provides the rest). The liver also filters harmful substances from the blood, digests fats, and stores sugar for later use.
Image by TheVisualMD
Alanine Aminotransferase (ALT): Liver and Intestines
The liver is the body's central chemical plant, removing toxins, storing sugars and lipids and producing a wide range of proteins that play key roles as enzymes. The liver also produces most of body's supply of cholesterol (the rest comes from food).
Image by TheVisualMD
Alanine Aminotransferase (ALT): Alcoholism
Cirrhosis is scarring of the liver and it can have many causes; among the most common are hepatitis and chronic alcoholism. Scarring of the liver is irreversible, but treating the cause (or eliminating alcohol) can keep it from getting worse.
Image by TheVisualMD
Important Liver Values Albumin, ALT, ALP & AST
Video by NKN/YouTube
Alanine Aminotransferase Nursing Considerations, Normal Range, Nursing Care, Lab Values Nursing
Video by NURSINGcom/YouTube
Alanine Aminotransferase (ALT): Liver lobule
TheVisualMD
Alanine Aminotransferase (ALT): Liver and Intestines
TheVisualMD
Alanine Aminotransferase (ALT): Alcoholism
TheVisualMD
7:55
Important Liver Values Albumin, ALT, ALP & AST
NKN/YouTube
2:58
Alanine Aminotransferase Nursing Considerations, Normal Range, Nursing Care, Lab Values Nursing
NURSINGcom/YouTube
AST
Aspartate Aminotransferase Test
Also called: AST, Serum Glutamic Oxaloacetic Transaminase, SGOT
Aspartate aminotransferase (AST) is an enzyme that can be found throughout the body, especially in the liver. When your liver is damaged, this enzyme gets released; therefore, an AST test can be used to help diagnose liver disorders.
Aspartate Aminotransferase Test
Also called: AST, Serum Glutamic Oxaloacetic Transaminase, SGOT
Aspartate aminotransferase (AST) is an enzyme that can be found throughout the body, especially in the liver. When your liver is damaged, this enzyme gets released; therefore, an AST test can be used to help diagnose liver disorders.
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Use the slider below to see how your results affect your
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U/L
10
40
Your result is Normal.
AST, or aspartate aminotransferase, is one of the two liver enzymes. AST is a protein made by liver cells. AST is also found in parts of the body other than the liver—including the heart, kidneys, muscles, and brain. When AST leaks out into the bloodstream it means that cells in any of those parts of the body are damaged.
Related conditions
AST (aspartate aminotransferase) is an enzyme that is found mostly in the liver, but it's also in muscles and other organs in your body. When cells that contain AST are damaged, they release the AST into your blood. An AST blood test measures the amount of AST in your blood. The test is commonly used to help diagnose liver damage or disease.
An AST blood test is often part of a routine blood screening to check the health of your liver. The test may help diagnose or monitor liver problems. It may also help diagnose other health conditions.
You may get an AST blood test as part of your routine checkup or if you have symptoms of liver damage. These may include:
Nausea and vomiting
Lack of appetite
Fatigue
Weakness
Jaundice, a condition that causes your skin and eyes to turn yellow
Even if you don't have symptoms, your health care provider may order an AST blood test if you're more likely to develop liver disease because of:
A family history of liver disease
Alcohol use disorder
Obesity
Diabetes
Taking certain medicines that can cause liver damage
Hepatitis or exposure to hepatitis
A health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.
You don't need any special preparations for an AST blood test. But an AST test is usually ordered with other blood tests. You usually need to fast (not eat or drink) for up to 12 hours before these tests. Your provider will let you know if there are any special instructions to follow.
There is very little risk to having a blood test. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.
High levels of AST in the blood may be a sign of hepatitis, cirrhosis, mononucleosis, or other liver diseases. High AST levels may also be a sign of heart problems or pancreatitis.
If your results are not in the normal range, it doesn't always mean that you have a medical condition that needs treatment. Many things can affect your results, such as certain medicines and your age, sex, and diet. To learn what your results mean, talk with your provider.
Your health care provider may order an ALT blood test with your AST blood test. ALT stands for alanine transaminase, which is another type of liver enzyme. If you have high levels of AST and/or ALT, it may mean that you have some type of liver damage.
You may also have an AST test as part of a group of liver function tests that measure ALT, and other enzymes, proteins, and substances in the liver.
AST Test: MedlinePlus Lab Test Information [accessed on Dec 20, 2023]
Aspartate aminotransferase (AST) blood test: MedlinePlus Medical Encyclopedia [accessed on Dec 20, 2023]
AST (SGOT): Liver Function Test - Viral Hepatitis and Liver Disease [accessed on Dec 20, 2023]
Additional Materials (2)
Aspartate Aminotransferase (AST): Liver
The liver is one of the body's most important chemical plants, producing proteins such as albumin and those that are involved in blood clotting. The liver also produces about half of the total cholesterol in the body (the other half comes from food), as well as filters harmful substances from the blood, digests fats and stores sugar for later use.
Image by TheVisualMD
Aspartate Aminotransferase (AST): Diabetic
Many people have more than one cause of liver damage. Obesity and diabetes are increasingly common causes of liver disease, especially in combination with alcohol, hepatitis C, or both.
Image by TheVisualMD
Aspartate Aminotransferase (AST): Liver
TheVisualMD
Aspartate Aminotransferase (AST): Diabetic
TheVisualMD
GGT
Gamma-Glutamyl Transferase Test
Also called: GGT, Gamma-glutamyl transpeptidase, GGTP, Gamma-GT, GTP
A gamma-glutamyl transferase (GGT) test measures the amount of GGT in the blood. GGT is a liver enzyme. High levels of GGT are a sign of liver damage. GGT can't diagnose the cause of liver damage, so it's usually done with other liver tests.
Gamma-Glutamyl Transferase Test
Also called: GGT, Gamma-glutamyl transpeptidase, GGTP, Gamma-GT, GTP
A gamma-glutamyl transferase (GGT) test measures the amount of GGT in the blood. GGT is a liver enzyme. High levels of GGT are a sign of liver damage. GGT can't diagnose the cause of liver damage, so it's usually done with other liver tests.
{"label":"GGT reference range","scale":"lin","step":0.1,"hideunits":false,"items":[{"flag":"borderline","label":{"short":"Low","long":"Low","orientation":"horizontal"},"values":{"min":0,"max":8},"text":"Low or normal GGT levels show no existing liver condition and show that there has been no alcohol consumption.","conditions":[]},{"flag":"normal","label":{"short":"Normal","long":"Normal","orientation":"horizontal"},"values":{"min":8,"max":61},"text":"GGT is an enzyme found mainly in the liver and is normally present in low levels in the blood.","conditions":[]},{"flag":"abnormal","label":{"short":"High","long":"High","orientation":"horizontal"},"values":{"min":61,"max":200},"text":"An elevated GGT level suggests that a condition or disease is damaging the liver; and usually, the higher the level, the greater the damage to the liver.","conditions":["Alcoholism","Diabetes","Cholestasis","Heart failure","Hepatitis","Lack of blood flow to the liver","Death of liver tissue","Liver cancer or tumor","Lung disease","Pancreas disease","Cirrhosis","Use of nephrotoxic drugs"]}],"units":[{"printSymbol":"U\/L","code":"U\/L","name":"enzyme unit per liter"}],"value":34.5}[{"borderline":0},{"normal":0},{"abnormal":0}]
Use the slider below to see how your results affect your
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U/L
8
61
Your result is Normal.
GGT is an enzyme found mainly in the liver and is normally present in low levels in the blood.
Related conditions
A gamma-glutamyl transferase (GGT) test measures the amount of GGT in the blood. GGT is an enzyme found throughout the body, but it is mostly found in the liver. When the liver is damaged, GGT may leak into the bloodstream. High levels of GGT in the blood may be a sign of liver disease or damage to the bile ducts. Bile ducts are tubes that carry bile in and out of the liver. Bile is a fluid made by the liver. It is important for digestion.
A GGT test can't diagnose the specific cause of liver disease. So it is usually done along with or after other liver function tests, most often an alkaline phosphatase (ALP) test. ALP is another type of liver enzyme. It's often used to help diagnose bone disorders as well as liver disease.
A GGT test is most often used to:
Help diagnose liver disease
Figure out if liver damage is due to liver disease or a bone disorder
Check for blockages in the bile ducts
Screen for or monitor alcohol use disorder
You may need a GGT test if you have symptoms of liver disease. Symptoms include:
Fatigue
Weakness
Jaundice, a condition that causes your skin and eyes to turn yellow
Loss of appetite
Abdominal pain or swelling
Nausea and vomiting
You may also need this test if you had abnormal results on an ALP test and/or other liver function tests.
A health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.
You don't need any special preparations for a GGT test.
There is very little risk to having a blood test. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.
If your results show higher than normal levels of GGT, it may be a sign of liver damage. The damage may be due to one of the following conditions:
Hepatitis
Cirrhosis
Alcohol use disorder
Pancreatitis
Diabetes
Congestive heart failure
Side effect of a drug. Certain medicines can cause liver damage in some people.
The results can't show which condition you have, but it can help show how much liver damage you have. Usually, the higher the level of GGT, the greater the level of damage to the liver.
If your results show you have low or normal levels of GGT, it means you probably don't have liver disease.
Your results may also be compared with the results of an ALP test. ALP tests help diagnose bone disorders. Together your results may show one of the following:
High levels of ALP and high levels of GGT means your symptoms are likely due to liver disorder and not a bone disorder.
High levels of ALP and low or normal GGT means it's more likely you have a bone disorder.
If you have questions about your results, talk to your health care provider.
In addition to an ALP test, your provider may order liver function tests along with or after the GGT test. These include:
Alanine aminotransferase, or ALT
Aspartate aminotransferase, or AST
Lactic dehydrogenase, or LDH
Gamma-glutamyl transferase (GGT) blood test: MedlinePlus Medical Encyclopedia [accessed on Sep 13, 2018]
Gamma-Glutamyl Transferase (GGT) - Understand the Test & Your Results [accessed on Sep 13, 2018]
What Is the Gamma-Glutamyl Transpeptidase (GGT) Test? [accessed on Sep 13, 2018]
http://www.irondisorders.org/Websites/idi/files/Content/1050668/ST%20four%20tests.pdf [accessed on Sep 13, 2018]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Additional Materials (3)
Gamma-Glutamyl Transferase: Liver
The liver is one of the body's most important chemical plants, producing proteins such as albumin and those that are involved in blood clotting. The liver also produces about half of the total cholesterol in the body (the other half comes from food).
Image by TheVisualMD
Gamma-Glutamyl Transferase: Alcoholism
Alcoholic liver disease is linked to the length of time alcohol is consumed, as well as quantity, though not all heavy drinkers develop it; genetics and gender also play roles. Symptoms include liver inflammation, enlargement, and eventually scarring (cirrhosis).
Image by TheVisualMD
Gamma-Glutamyl Transferase: Biliary System
The biliary system consists of the organs and ducts that produce and transport bile. The function of bile is twofold: it drains wastes from the liver and aids in digestion. Bile is released into the duodenum (part of the small intestine) when a person eats.
Image by TheVisualMD
Gamma-Glutamyl Transferase: Liver
TheVisualMD
Gamma-Glutamyl Transferase: Alcoholism
TheVisualMD
Gamma-Glutamyl Transferase: Biliary System
TheVisualMD
Bilirubin
Bilirubin Blood Test
Also called: Bilirubin, Hypobilirubinemia Test, Hyperbilirubinemia Test
A bilirubin blood test measures the levels of bilirubin in your blood. Bilirubin is a yellowish substance that is created by the breakdown (destruction) of hemoglobin, a major component of red blood cells. High bilirubin levels may be a sign of liver disease.
Bilirubin Blood Test
Also called: Bilirubin, Hypobilirubinemia Test, Hyperbilirubinemia Test
A bilirubin blood test measures the levels of bilirubin in your blood. Bilirubin is a yellowish substance that is created by the breakdown (destruction) of hemoglobin, a major component of red blood cells. High bilirubin levels may be a sign of liver disease.
{"label":"Bilirubin reference range","scale":"lin","step":0.1,"hideunits":false,"items":[{"flag":"normal","label":{"short":"Normal","long":"Normal","orientation":"horizontal"},"values":{"min":0,"max":1.2},"text":"Bilirubin is a yellowish substance that is created by the breakdown (destruction) of hemoglobin, a major component of red blood cells. As red blood cells age, they are broken down naturally in the body. Bilirubin is released from the destroyed red blood cells and passed on to the liver. The liver releases the bilirubin in into the bile.","conditions":[]},{"flag":"abnormal","label":{"short":"High","long":"High","orientation":"horizontal"},"values":{"min":1.2,"max":4},"text":"High bilirubin results may mean that you have a liver problem, hepatitis, or gallstones. Vigorous exercise can raise bilirubin levels. Men have slightly higher levels of bilirubin than women. African Americans also have slightly higher levels of bilirubin than people of other ethnic backgrounds.","conditions":["Hyperbilirubinemia","Alcoholism","Liver disease","Hepatitis","Cirrhosis","Gilbert disease","Dubin-Johnson syndrome","Septicemia","Hemolytic or pernicious anemia","Sickle cell anemia","Certain cancers or tumors","Certain rare inherited diseases","Gallstones","Biliary stricture","Cholangitis","Scarring of the bile ducts"]}],"units":[{"printSymbol":"mg\/dL","code":"mg\/dL","name":"milligram per deciliter"}],"value":0.6}[{"normal":0},{"abnormal":0}]
Use the slider below to see how your results affect your
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mg/dL
1.2
Your result is Normal.
Bilirubin is a yellowish substance that is created by the breakdown (destruction) of hemoglobin, a major component of red blood cells. As red blood cells age, they are broken down naturally in the body. Bilirubin is released from the destroyed red blood cells and passed on to the liver. The liver releases the bilirubin in into the bile.
Related conditions
A bilirubin blood test measures the levels of bilirubin in your blood. Bilirubin is a yellowish substance made during your body's normal process of breaking down old red blood cells. Bilirubin is found in bile, a fluid your liver makes that helps you digest food.
If your liver is healthy, it will remove most of the bilirubin from your body. If your liver is damaged, bilirubin can leak out of your liver and into your blood. When too much bilirubin gets into the bloodstream, it can cause jaundice, a condition that causes your skin and eyes to turn yellow. Signs of jaundice, along with a bilirubin blood test, can help your health care provider find out if you have liver disease.
A bilirubin blood test is used to check the health of your liver. The test is also commonly used to help diagnose newborn jaundice. Many healthy babies get jaundice because their livers aren't developed enough to get rid of enough bilirubin. Newborn jaundice is usually not harmful and clears up within a few weeks. But in some cases, high bilirubin levels can lead to brain damage, so infants are often tested as a precaution.
Your provider may order a bilirubin blood test:
If you have symptoms such as jaundice, dark urine, or stomach pain. These could be symptoms of hepatitis, cirrhosis, or other liver diseases. They may also be signs of gallbladder disease.
To find out if there is a blockage in the bile ducts, the tubes that carry bile from your liver.
To check on an existing liver disease or disorder.
To diagnose disorders related to problems with breaking down red blood cells. High bilirubin levels in the bloodstream may be a sign of a condition called hemolytic anemia. In this condition, the body destroys red blood cells faster than it makes them.
A health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.
Your health care provider may tell you to fast (not eat or drink) for four hours before your blood test. If there are any other special instructions, your provider will let you know.
There is very little risk to having a blood test. You may experience slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.
Normal results can vary, but high bilirubin levels may mean your liver isn't working right. However, abnormal results don't always mean you have a medical condition that needs treatment. Other things may cause higher than normal bilirubin levels, such as certain medicines and foods or strenuous exercise. To learn what your results mean, talk with your provider.
A bilirubin blood test is only one measure of your liver health. If your provider thinks you might have a liver disease or a red blood cell disorder, you may need other tests. These tests may include:
Liver function tests, a group of tests that measure different substances in your blood.
Liver protein tests
Urine tests
An ultrasound
A liver biopsy to get a sample of your liver tissue to examine under a microscope.
Bilirubin Blood Test: MedlinePlus Medical Test [accessed on Dec 20, 2023]
Bilirubin blood test: MedlinePlus Medical Encyclopedia [accessed on Dec 20, 2023]
Bilirubin: Liver Function Test - Viral Hepatitis and Liver Disease [accessed on Dec 20, 2023]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Additional Materials (6)
Bilirubin Metabolism
Video by Armando Hasudungan/YouTube
What is jaundice?
Video by Eugene Pediatric Associates/YouTube
Bilirubin Metabolism Simplified
Video by MEDSimplified/YouTube
BABY WITH JAUNDICE (Hyperbilirubinemia) | Dr. Paul
Video by paulthomasmd - Dr. Paul/YouTube
Bilirubin, Direct: Red Blood Cells
There are 20 to 30 trillion red blood cells circulating through the body of an adult. Individual red blood cells live about 100 days, which means that about 2 million die (and an equal number replaced) every second. Bilirubin is left behind after these older blood cells are removed.
Image by TheVisualMD
Eye with Yellow Conjunctiva, Jaundice
When damaged or dying red blood cells are broken down in the spleen, bilirubin, a yellow pigment and component of hemoglobin, is released into the bloodstream. The waste bilirubin is usually efficiently eliminated from the body by the liver (the pigmented waste becomes a component of bile, which is stored in the gallbladder and released into the duodenum of the small intestine to aid in digestion). Various diseases of the liver or bile ducts, however, can result in the accumulation of bilirubin in the body, causing jaundice, a yellowing of the skin and whites of the eyes.
Image by TheVisualMD
8:44
Bilirubin Metabolism
Armando Hasudungan/YouTube
2:20
What is jaundice?
Eugene Pediatric Associates/YouTube
2:35
Bilirubin Metabolism Simplified
MEDSimplified/YouTube
3:20
BABY WITH JAUNDICE (Hyperbilirubinemia) | Dr. Paul
This test measures the level of lactate dehydrogenase (LDH) in blood or other body fluids. LDH is an enzyme involved in energy production. High levels may be a sign of tissue damage or disease.
This test measures the level of lactate dehydrogenase (LDH) in blood or other body fluids. LDH is an enzyme involved in energy production. High levels may be a sign of tissue damage or disease.
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Use the slider below to see how your results affect your
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U/L
100
200
Your result is Normal.
Normal levels can vary depending on the person's age and the method used for testing.
Related conditions
A lactate dehydrogenase (LDH) test usually measures the level of lactate dehydrogenase (LDH) in a sample of your blood. In certain cases, LDH levels are measured in samples of other body fluids. This includes testing fluid from the spine (cerebrospinal fluid), the belly (peritoneal fluid), and the chest (pleural fluid).
LDH is also called lactic acid dehydrogenase. It is an enzyme. An enzyme is a protein that speeds up certain chemical reactions in your body. LDH helps your cells make energy. It is found in almost all the tissues in your body. The largest amounts of LDH are found in your muscles, liver, kidneys, and red blood cells.
If disease or injury damages tissues that have LDH, their cells release the enzyme into your bloodstream or other body fluids. It's normal to have some LDH in your blood and body fluids. But if your LDH levels are high, it may be a sign of certain diseases or injuries.
An LDH test alone can't show what is damaging your tissues or where the damage is located. So, an LDH test is usually done with other types of tests that can help diagnose the problem.
Other names: LD test, lactic dehydrogenase, lactic acid dehydrogenase
LDH is mainly used to check for tissue damage. Many types of acute (sudden) and chronic (long-lasting) conditions can damage tissues and cause high LDH levels. So LDH testing may be used in many different situations from bone and muscle injuries to monitoring treatment for cancer. For example, an LDH test may be used to:
Help diagnose and/or monitor diseases that affect the:
Blood, including anemia
Liver
Lungs
Kidneys
Heart, including heart attack
Pancreas
Brain and spinal cord, such as encephalitis and bacterial meningitis
Help monitor conditions that may get worse over time, such as muscular dystrophy and HIV
Help diagnose certain severe infections
Find out how serious certain types of cancer may be, including multiple myeloma, lymphoma, leukemia, testicular cancer, and melanoma.
Check whether treatment for certain types of cancer is working
Because LDH testing is used for so many conditions, it's best to ask your health care provider why you need an LDH test. In general, the test is ordered if other tests and/or your symptoms suggest you have tissue damage or disease.
If you have a disease that affects LDH levels, you may need an LDH test to learn more about your condition and to find out if your treatment is helping.
A health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.
If your provider thinks you have a condition that may affect LDH levels in other body fluids, you may have a procedure to get a fluid sample. These procedures may include:
A lumbar puncture or "spinal tap" to collect cerebrospinal fluid that flows around your brain and spinal cord
A thoracentesis to remove fluid in the chest
A paracentesis or "abdominal tap" to remove fluid from the abdomen
If you are having one of these tests, your provider will explain the procedure.
You don't need any special preparations for an LDH blood test. If your test uses other fluid samples, your provider will tell you how to prepare.
There is very little risk to having a blood test. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly. If you are having another type of test, your provider will explain the risks.
LDH testing is used for many reasons. The meaning of your LDH test results depends on the reason you had the test, your symptoms, and the results of other tests you've had. So, ask your provider to explain what your results say about your health.
In general, LDH levels that are higher than normal usually mean you have some type of tissue damage. The damage is usually from disease, infection, or injury. Your provider may order more tests to diagnose your condition.
But higher a than normal LDH level doesn't always mean you have a medical condition that needs treatment. High levels can be caused by intense exercise and certain medicines, including aspirin. It's also possible to have a high LDH level if many red blood cells broke open when your sample was collected and tested.
Lower than normal LDH levels aren't common and usually aren't considered to be a health problem. Taking large amounts of vitamin C or vitamin E may cause low levels. Low LDH levels may also be caused by a rare genetic disorder called lactate dehydrogenase deficiency.
If your results showed higher than normal LDH levels, your provider may order a more specific type of LDH test that can help find out where the LDH is coming from. This more specific test is called an LDH isoenzyme test.
An LDH isoenzyme test measures the levels of five different forms of LDH. This information helps your provider find out about the type of tissue that's damaged, where in the body it may be, and how serious the damage may be.
Lactate Dehydrogenase (LDH) Test: MedlinePlus Medical Test [accessed on Jan 28, 2024]
Lactic Acid Dehydrogenase (Blood) - Health Encyclopedia - University of Rochester Medical Center [accessed on Oct 16, 2018]
LabCorp Test Menu / 001115: Lactic Acid Dehydrogenase (LD) [accessed on Oct 16, 2018]
LD - Clinical: Lactate Dehydrogenase (LD), Serum [accessed on Oct 16, 2018]
Lactate Dehydrogenase (LDH) - Understand the Test & Your Results [accessed on Oct 16, 2018]
Lactate dehydrogenase test: MedlinePlus Medical Encyclopedia [accessed on Oct 16, 2018]
Lactate Dehydrogenase Test: Types, Procedure, and Results [accessed on Oct 16, 2018]
Lactate dehydrogenase deficiency - Genetics Home Reference - NIH [accessed on Oct 16, 2018]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Complications after a heart attack (myocardial infarction) | NCLEX-RN | Khan Academy
Video by khanacademymedicine/YouTube
Preventing Stroke (Stroke #4)
Video by Healthguru/YouTube
Understanding Stroke (Stroke #1)
Video by Healthguru/YouTube
Stroke - Carotid Artery Disease and TIA
Video by EdwardHospital/YouTube
3D Medical Animation - What is a Heart Attack?
Video by BioDigital, Inc./YouTube
Cerebral hemorrhage
Cerebral hemorrhage : This image shows an Intracerebral and Intraventricular hemorrhage of a young woman. The woman was one week post partum, with no known trauma involved.
Image by Glitzy queen00
Cerebral hemorrhage
Cerebral hemorrhage : Spontaneous ICH with hydrocephalus on CT scan.
Image by Yadav YR, Mukerji G, Shenoy R, Basoor A, Jain G, Nelson A
Cerebral hemorrhage
Cerebral hemorrhage : An intracranial bleed with significant midline shift.
Image by James Heilman, MD
Ischemic Stroke
Ischemic Stroke: The illustration shows how an ischemic stroke can occur in the brain. If a blood clot breaks away from plaque buildup in a carotid (neck) artery, it can travel to and lodge in an artery in the brain. The clot can block blood flow to part of the brain, causing brain tissue death.
Image by National Heart Lung and Blood Insitute (NIH)
What Is a Heart Attack?
Diagram showing a heart attack (mycardial infaction).
Image by NIH: National Heart, Lung and Blood Institute
Patrick J. Lynch, medical illustrator; C. Carl Jaffe, MD, cardiologist
Ischemic Stroke
ConstructionDealMkting
PT/INR
Prothrombin Time Test and INR
Also called: PT/INR, Prothrombin Time, Prothrombin Time/International Normalized Ratio, PT Protime
A prothrombin time test (PT) measures the time it takes for a clot to form in a blood sample. An INR is a calculation based on the results of a PT test. A PT/INR test is used to see if your blood is clotting normally and if warfarin is effective in treating clotting disorders.
Prothrombin Time Test and INR
Also called: PT/INR, Prothrombin Time, Prothrombin Time/International Normalized Ratio, PT Protime
A prothrombin time test (PT) measures the time it takes for a clot to form in a blood sample. An INR is a calculation based on the results of a PT test. A PT/INR test is used to see if your blood is clotting normally and if warfarin is effective in treating clotting disorders.
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Use the slider below to see how your results affect your
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s
11
13.5
Your result is Normal.
The average time range for blood to clot is about 11 to 13.5 seconds. If you are taking blood thinning drugs, your results should be interpreted using the international normalized ratio (INR).
Related conditions
{"label":"INR reference range","scale":"lin","step":0.1,"hideunits":false,"items":[{"flag":"abnormal","label":{"short":"Low","long":"Low","orientation":"horizontal"},"values":{"min":0,"max":2},"text":"If the INR is below the target range there is an increased risk of clotting. The dose of blood thinner may be increased to get the PT\/INR blood test into the correct range.","conditions":["Early stages of disseminated intravascular coagulation","Cancer (except in the liver)","Severe tissue inflammation or trauma","Errors when taking or processing the blood sample"]},{"flag":"normal","label":{"short":"Optimal","long":"Optimal","orientation":"horizontal"},"values":{"min":2,"max":3},"text":"The target (optimal therapeutic) INR range depends on why you are taking the blood thinner. In most cases the target INR range will be between 2 and 3, although other ranges may be chosen if there are special circumstances.","conditions":[]},{"flag":"abnormal","label":{"short":"High","long":"High","orientation":"horizontal"},"values":{"min":3,"max":6},"text":"If the INR is above the target range there is an increased risk of uncontrolled or dangerous bleeding. Close monitoring is needed until the risk of bleeding is reduced. The dose of blood thinner may be lowered to get the PT\/INR blood test into the correct range.","conditions":["Bleeding disorders","Liver disease","Low level of vitamin K","Insufficiency of one or more proteins involved in the coagulation cascade","Disseminated intravascular coagulation"]}],"units":[{"printSymbol":"{INR}","code":"{INR}","name":"international normalized ratio"}],"value":2.5}[{"abnormal":0},{"normal":0},{"abnormal":0}]
Use the slider below to see how your results affect your
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{INR}
2
3
Your result is Optimal.
The target (optimal therapeutic) INR range depends on why you are taking the blood thinner. In most cases the target INR range will be between 2 and 3, although other ranges may be chosen if there are special circumstances.
Related conditions
A prothrombin time (PT) test measures how long it takes for a clot to form in a blood sample. An INR (international normalized ratio) is a type of calculation based on PT test results.
Prothrombin is a protein made by the liver. It is one of several substances known as clotting (coagulation) factors. When you get a cut or other injury that causes bleeding, your clotting factors work together to form a blood clot. How fast your blood clots depends on the amount of clotting factors in your blood and whether they're working correctly. If your blood clots too slowly, you may bleed too much after an injury. If your blood clots too fast, dangerous clots may form in your arteries or veins.
A PT/INR test helps diagnose the cause of bleeding or clotting disorders. It also checks to see if a medicine that prevents blood clots is working the way it should.
Other names: prothrombin time/international normalized ratio, PT protime
A PT/INR test is most often used to:
See how well warfarin is working. Warfarin is a blood-thinning medicine that's used to treat and prevent dangerous blood clots. (Coumadin is a common brand name for warfarin.)
Find out the reason for abnormal blood clots
Find out the reason for unusual bleeding
Check clotting function before surgery
Check for liver problems
A PT/INR test is often done along with a partial thromboplastin time (PTT) test. A PTT test also checks for clotting problems.
You may need this test if you are taking warfarin on a regular basis. The test helps make sure you are taking the right dose.
If you are not taking warfarin, you may need this test if you have symptoms of a bleeding or clotting disorder.
Symptoms of a bleeding disorder include:
Unexplained heavy bleeding
Bruising easily
Unusually heavy nose bleeds
Unusually heavy menstrual periods in women
Symptoms of a clotting disorder include:
Leg pain or tenderness
Leg swelling
Redness or red streaks on the legs
Trouble breathing
Cough
Chest pain
Rapid heartbeat
In addition, you may need a PT/INR test if you are scheduled for surgery. It helps make sure your blood is clotting normally, so you won't lose too much blood during the procedure.
The test may be done on a blood sample from a vein or a fingertip.
For a blood sample from a vein:
A health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.
For a blood sample from a fingertip:
A fingertip test may be done in a provider's office or in your home. If you are taking warfarin, your provider may recommend you test your blood regularly using an at-home PT/INR test kit. During this test, you or your provider will:
Use a small needle to puncture your fingertip
Collect a drop of blood and place it onto a test strip or other special instrument
Place the instrument or test strip into a device that calculates the results. At-home devices are small and lightweight.
If you are using an at-home test kit, you will need to review your results with your provider. Your provider will let you know how he or she would like to receive the results.
If you are taking warfarin, you may need to delay your daily dose until after testing. Your health care provider will let you know if there are any other special instructions to follow.
There is very little risk to having a blood test. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.
If you were tested because you are taking warfarin, your results will probably be in the form of INR levels. INR levels are often used because they make it easier to compare results from different labs and different test methods. If you are not taking warfarin, your results may be in the form of INR levels or the number of seconds it takes for your blood sample to clot (prothrombin time).
If you are taking warfarin:
INR levels that are too low may mean you are at risk for dangerous blood clots.
INR levels that are too high may mean you are at risk for dangerous bleeding.
Your health care provider will probably change your dose of warfarin to reduce these risks.
If you are not taking warfarin and your INR or prothrombin time results were not normal, it may mean one of the following conditions:
A bleeding disorder, a condition in which the body can't clot blood properly, causing excessive bleeding
A clotting disorder, a condition in which the body forms excessive clots in arteries or veins
Liver disease
Vitamin K deficiency. Vitamin K plays an important role in blood clotting.
Sometimes certain liver tests are ordered along with a PT/INR test. These include:
Aspartate Aminotransferase (AST)
Alanine Aminotransferase (ALT)
Prothrombin Time Test and INR (PT/INR): MedlinePlus Medical Test [accessed on Mar 06, 2024]
Prothrombin time (PT): MedlinePlus Medical Encyclopedia [accessed on Mar 06, 2024]
PT/INR Test (Prothrombin Time and International Normalized Ratio) - Testing.com. Nov 9, 2021 [accessed on Mar 06, 2024]
Patient education: Warfarin (Beyond the Basics). UpToDate [accessed on Mar 06, 2024]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Additional Materials (10)
Prothrombin Time (PT): Pulmonary Embolism
The most dangerous complication of deep vein thrombosis (DVT) is pulmonary embolism, which occurs when an embolism travels through the heart and into the lungs. There it lodges in an artery, typically where the artery forks, and blocks blood flow. During an episode of pulmonary embolism, the lungs may be showered with blood clots. The lungs are particularly vulnerable to embolisms because all the blood in the body passes through the lungs every time it circulates.
Image by TheVisualMD
Blood clots
This medical illustration reveals how the SHELTERTM device traps and removes blood clots in the brain.
Image by Zina Deretsky, NSF
Blood clots
Red blood cells trapped in a fibrin network in a blood clot.
Image by Fuzis
Factors V, VII, KIF6: Thrombosis
Thrombosis is the formation of a blood clot inside a blood vessel. If the clot is large or persistent enough, it can obstruct blood flow, which can starve tissue or entire organs of oxygen-carrying blood. Most strokes are the result of thrombosis.
Image by TheVisualMD
Platelets: Thrombus Formation
Thrombosis is the formation of a blood clot (thrombus) inside a blood vessel. If the clot is large or persistent enough, it can obstruct blood flow, which can starve tissue of oxygen-carrying blood. Most strokes are the result of thrombosis.
Image by TheVisualMD
Skin Cross Section with Razor Cut
When the skin is injured an inflammatory response is triggered to rid the body of harmful invaders. To begin this response mast cells and basophils secrete chemical signals that promote blood flow to the area.
Image by TheVisualMD
INR Nursing Considerations, Normal Range, Nursing Care, Lab Values Nursing
Also called: Carcinoembryonic Antigen, CEA Assay, CEA Tumor Marker
A CEA (carcinoembryonic antigen) test measures CEA in a sample of blood or other body fluid. It helps check if treatment for certain cancers is working. The test is most commonly used in colorectal cancer.
CEA Test
Also called: Carcinoembryonic Antigen, CEA Assay, CEA Tumor Marker
A CEA (carcinoembryonic antigen) test measures CEA in a sample of blood or other body fluid. It helps check if treatment for certain cancers is working. The test is most commonly used in colorectal cancer.
{"label":"CEA reference range","scale":"lin","step":0.1,"hideunits":false,"items":[{"flag":"normal","label":{"short":"N","long":"Normal","orientation":"horizontal"},"values":{"min":0,"max":3},"text":"CEA is normally found in small amounts in the blood. Most healthy non-smoking people (97%) have values < or =3.0 ng\/mL. Some smokers may have elevated CEA, usually <5.0 ng\/mL.","conditions":[]},{"flag":"borderline","label":{"short":"E","long":"Elevated","orientation":"horizontal"},"values":{"min":3,"max":5},"text":"Most healthy non-smoking people (97%) have values < or =3.0 ng\/mL. Some smokers may have elevated CEA, usually <5.0 ng\/mL.","conditions":[]},{"flag":"abnormal","label":{"short":"H","long":"High","orientation":"horizontal"},"values":{"min":5,"max":20},"text":"A high CEA level in a person recently treated for certain cancers may mean the cancer has returned.","conditions":["Colorectal cancer"]},{"flag":"abnormal","label":{"short":"VH","long":"Very high","orientation":"horizontal"},"values":{"min":20,"max":40},"text":"Highly elevated CEA concentrations (>20 ng\/mL) in a patient with compatible symptoms are strongly suggestive of the presence of cancer and also suggest metastasis.","conditions":["Colorectal cancer"]}],"units":[{"printSymbol":"ng\/mL","code":"ng\/mL","name":"nanogram per milliliter"}],"value":1.5}[{"normal":0},{"borderline":0},{"abnormal":0},{"abnormal":1}]
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3
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20
Your result is Normal.
Related conditions
CEA stands for carcinoembryonic antigen. CEA is a protein that is a type of "tumor marker." Tumor markers are substances that are often made by cancer cells or by normal cells in response to cancer.
High levels of CEA are normal in healthy, unborn babies. After birth, CEA levels become very low or disappear completely. So, healthy adults should have little or no CEA in their bodies.
Cancers that may cause high levels of CEA include cancers of the:
Colon and rectum (colorectal or bowel cancer)
Prostate
Ovary
Lung
Thyroid
Liver
Pancreas
Breast
If you've been diagnosed with a cancer that can cause high CEA levels, CEA testing may help your health care provider learn more about your cancer and chance of recovery. The test is often used with other tests to check if cancer treatment is working.
CEA tests are not used to screen for or diagnose cancer. That's because:
Cancers that often cause high CEA levels don't always cause high levels. You can have normal CEA test results even though you have one of these cancers.
Many other health problems that aren't cancer can make CEA levels rise, including certain conditions that affect your liver, digestion, or breathing.
Most CEA tests use a sample of your blood to measure your CEA level. Sometimes the test uses a sample of fluid from your spine, chest, or abdomen (belly), but this is less common.
A CEA test is mostly used in people who have been diagnosed with cancers that often increase CEA levels. It's most commonly used in colorectal cancer. A provider may order a CEA test along with other tests to:
Learn more about a cancer soon after it has been diagnosed. CEA levels can help predict the likelihood of recovery and/or the chance that cancer will come back after treatment.
Check how well cancer treatment is working.
See if cancer has returned after treatment.
If you've been diagnosed with a type of cancer that can cause high CEA levels, you may need CEA testing:
Before treatment to:
Help understand how serious your cancer is.
Help guide treatment decisions.
Get a measurement of your CEA level before treatment to compare with CEA levels after treatment.
During cancer treatment to see if the treatment working.
After treatment to check whether cancer has come back. You may need to have tests on a regular schedule.
CEA is usually measured with a blood sample. During a CEA blood test, a health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.
Sometimes, CEA is tested in other body fluids. For these tests, your provider will remove a small sample of fluid using a thin needle.
For a CEA blood test, you usually don't need to prepare. If you smoke, you may need to stop for a while before your test. That's because smoking increases CEA levels.
A CEA blood test has very little risk. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.
To understand your CEA test results, your provider will consider the results of other tests and exams. Ask your provider to explain what your test results mean for your health and treatment.
If you had a test before starting cancer treatment, in general:
A low level of CEAmay mean your tumor is small and the cancer has not spread to other parts of your body. But some cancers don't make much CEA, so your provider may use other tests to learn more about how much cancer you have and if it's spread.
A high level of CEAmay mean you have a larger tumor and/or your cancer has spread. You'll need other tests to confirm how serious your cancer is.
If you had a test to monitor your cancer during or after treatment, your provider will compare your current CEA test results with your past test results. In general:
Decreases in CEA over time often mean that treatment is working.
Increases in CEA or high levels that stay highmay mean that treatment isn't working. For example, if you had surgery for colorectal cancer, these levels may mean that the entire tumor wasn't removed or the cancer is growing back.
Decreases in CEA after treatment followed by increasesmay mean cancer has come back.
CEA levels that remain high or increase after treatment don't always mean that treatment isn't working, or cancer is growing. So, if your CEA levels don't come down, your provider will likely order other tests to find out why.
If you have questions about your results, talk with your provider.
Labs use different methods to measure CEA. The test method can affect your results. So, its best to have your tests done the same way, and usually in the same lab. This allows your provider to compare your results over time. If you have questions about how your tests are done, ask your provider.
CEA Test: MedlinePlus Medical Test [accessed on Mar 09, 2023]
https://www.cancer.gov/about-cancer/diagnosis-staging/diagnosis/tumor-markers-fact-sheet [accessed on Mar 13, 2019]
https://www.labcorp.com/test-menu/21906/carcinoembryonic-antigen-cea [accessed on Oct 03, 2019]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Additional Materials (20)
Carcinoembryonic Antigen (CEA): CEA in Colorectal Cancer Staging and Treatment
CEA tests are not used to screen for colorectal cancer, but they're frequently performed after the cancer has been diagnosed. CEA is useful in staging--performing tests to determine if the cancer has spread within the intestine or to distant parts of the body. CEA may also be used for treatment planning, as elevated levels may indicate a poorer prognosis. After surgery, CEA levels may be measured periodically to see if the cancer has spread. It is important to note that CEA is not a perfect predictor of how a patient will respond to treatment, nor is it conclusive in determining if cancer has spread. The American Society of Clinical Oncologists (ASCO) states that CEA should not be used as the sole basis for decision-making in colorectal cancer.
Image by TheVisualMD
Carcinoembryonic Antigen (CEA): CEA Testing During Chemotherapy
Whether CEA is tested during systemic treatment for colorectal cancer depends on the stage of the cancer. After surgery, the American Society of Clinical Oncologists (ASCO) recommends that patients with stage II or stage III cancer have a CEA test every 3 months, for a minimum of 3 years. However, if the patient is receiving chemotherapy, CEA testing should be delayed until after chemotherapy is completed. On the other hand, CEA is the marker of choice for monitoring stage IV (metastatic) colorectal cancer during systemic treatment. Patients with metastatic cancer, in which the cancer has spread to distant parts of the body, should have a CEA test every 1-3 months during chemotherapy to see if the treatment is working and whether the cancer is still spreading. ASCO recommends other tests be done in conjunction with the CEA tests.
Image by TheVisualMD
The Importance of Good Bowel Preparation During Colonoscopy
Video by Johns Hopkins Medicine/YouTube
Colon cancer: Essential facts
Video by Institute for Cancer Genetics and Informatics/YouTube
The Colon and Colon Cancer
Video by Armando Hasudungan/YouTube
Colon Cancer: Don't Ignore Your Symptoms
Video by American Cancer Society/YouTube
Colorectal Cancer Screening
Video by Mechanisms in Medicine/YouTube
This browser does not support the video element.
Treating Colon Cancer
This animation explains how colon cancer forms and how it can be treated through chemotherapy and surgery.
Video by TheVisualMD
This browser does not support the video element.
Colorectal Cancer Screening
Colorectal cancer is one of the few preventable forms of cancer thanks to effective screening. For many people, screening for colorectal cancer is an unpleasant thought, but knowing your options and taking a pro-active approach especially if you're over 50 can save your life. In this video, you can learn the "ins and outs" of colonoscopy, as well as learn about a new technique called virtual colonoscopy, which uses high-tech CT scans to screen the colon.
Video by TheVisualMD
This browser does not support the video element.
Colorectal Cancer Clip 6
Colorectal Cancer Clip 6
Video by TheVisualMD
This browser does not support the video element.
Dr. O'Kieffe and patient on preparing for a colonoscopy
A recent colonoscopy patient and gastroenterologist Dr. Donald O'Kieffe of Metro Gastroenterology, Chevy Chase, MD, explain what's involved in the preparation for your screening.
Video by TheVisualMD
This browser does not support the video element.
Dr. Klein on who should be screened
Dr. Mark Klein, a radiologist and colorectal cancer screening specialist at Washington Radiology Associates in Washington, DC, discusses who should be screened for colorectal cancer, and when.
Video by TheVisualMD
Colon cancer staging
Colon cancer staging : After colon cancer has been diagnosed, the next step is to perform tests to determine if the cancer has spread within the intestine or to distant parts of the body. This is called staging. Staging helps the doctor to decide the most appropriate treatment for the cancer at its current stage.
Image by TheVisualMD
Colorectal Cancer Types of Surgery
Surgery is the main treatment for colorectal cancer. Polyps and very early stage cancers (Stage 0 and some early Stage I tumors) can be removed during a colonoscopy, using a variety of techniques. In late Stage I and in Stage II and III cancer, the cancerous part of the colon is removed surgically. The surgeon may perform a resection, consisting of a partial colectomy (removing the cancer and a small amount of healthy tissue around it) and an anastomosis (sewing the parts of the colon back together). Nearby lymph nodes may also be removed and biopsied. If it isn't possible to perform a resection (for instance, if the cancer is at the outlet of the rectum), a colostomy may be performed. In a colostomy, a portion of the large intestine is brought through the abdominal wall to carry stool out of the body, where it empties into a special bag. The colostomy may be temporary in order to allow the colon or rectum time to heal after surgery, or it may be permanent.
Image by TheVisualMD
Colon Anatomy & Function
Image by TheVisualMD
Colostomy
Colostomy Illustration
Image by Blausen.com staff. \"Blausen gallery 2014\". Wikiversity Journal of Medicine. DOI:10.15347/wjm/2014.010. ISSN 20018762
Colorectal Cancer
Colorectal cancer refers to cancer of the colon and cancer of the rectum. The colon is the longest part of the large intestine, and the rectum is the last several inches of the large intestine, closest to the anus.
Image by TheVisualMD
What Is Colorectal Cancer?
The process of cell growth in the body is normally an orderly one. Cells grow and divide as necessary to produce more cells as they are needed. Cells that are old or damaged die, and are replaced with new cells.
Image by TheVisualMD
Treating Colorectal Cancer
There are three main treatment options for colorectal cancer:
Image by TheVisualMD
Colorectal Cancer Spread to Body Stage 4
Cancer spreads in three ways: by invading surrounding tissue, by invading the lymph system and traveling through lymph vessels to other places in the body, and by invading veins and capillaries and traveling through the bloodstream to other places in the body. Stage IV: Cancer may have spread to nearby lymph nodes and has spread to other parts of the body, such as the liver or lungs. Stage IV colorectal cancer is not considered curable. Image 5 of 5.
Image by TheVisualMD
Carcinoembryonic Antigen (CEA): CEA in Colorectal Cancer Staging and Treatment
TheVisualMD
Carcinoembryonic Antigen (CEA): CEA Testing During Chemotherapy
TheVisualMD
1:23
The Importance of Good Bowel Preparation During Colonoscopy
Johns Hopkins Medicine/YouTube
2:49
Colon cancer: Essential facts
Institute for Cancer Genetics and Informatics/YouTube
10:05
The Colon and Colon Cancer
Armando Hasudungan/YouTube
6:06
Colon Cancer: Don't Ignore Your Symptoms
American Cancer Society/YouTube
2:42
Colorectal Cancer Screening
Mechanisms in Medicine/YouTube
3:45
Treating Colon Cancer
TheVisualMD
4:13
Colorectal Cancer Screening
TheVisualMD
0:05
Colorectal Cancer Clip 6
TheVisualMD
0:48
Dr. O'Kieffe and patient on preparing for a colonoscopy
Also called: CA 19-9 Tumor Marker, Carbohydrate Antigen 19-9, Pancreatic Cancer Antigen
CA 19-9 testing is mostly used to monitor the effectiveness of treatment in individuals who have been diagnosed with pancreatic cancer. However, this antigen can also be elevated in other conditions, diseases, or types of cancer.
CA 19-9 Blood Test
Also called: CA 19-9 Tumor Marker, Carbohydrate Antigen 19-9, Pancreatic Cancer Antigen
CA 19-9 testing is mostly used to monitor the effectiveness of treatment in individuals who have been diagnosed with pancreatic cancer. However, this antigen can also be elevated in other conditions, diseases, or types of cancer.
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Use the slider below to see how your results affect your
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U/mL
35
75
Your result is Low.
Low amounts of CA 19.9 may be detected in healthy people. Low or stable counts may also indicate positive response to treatment or stabilized tumor growth.
Related conditions
A CA 19-9 test measures the amount of a protein called CA 19-9 (cancer antigen 19-9) in a sample of your blood. CA 19-9 is a type of tumor marker. Tumor markers are substances made by cancer cells or by normal cells in response to cancer in your body.
Healthy people can have small amounts of CA 19-9 in their blood. High levels of CA 19-9 are often a sign of pancreatic cancer. But high levels can also be a sign of other types of cancer or certain conditions that aren't cancer. For example, gallstones and cirrhosis of the liver can cause high CA 19-9 levels.
Because high levels of CA 19-9 can mean different things, the test is not used by itself to screen for or diagnose cancer or other diseases. But it can help monitor your cancer and check how well your treatment is working.
Other names: cancer antigen 19-9, carbohydrate antigen 19-9, CA 199 measurement, CA 19-9 radioimmunoassay (RIA)
CA 19-9 blood tests may be used to:
Monitor certain types of cancer and cancer treatment. CA 19-9 levels often go up as cancer grows and go down as tumors shrink.
Help predict how cancer may behave over time.
Check whether cancer has returned after treatment.
Help diagnose certain cancers and other diseases when used with other tests.
Some people do not make CA 19-9 even when they have a cancer that usually produces high levels of CA 19-9. For these people, a CA 19-9 tumor marker test is not useful.
You may need a CA 19-9 blood test if you've been diagnosed with pancreatic cancer or another type of cancer that causes high CA 19-9. These include cancers of the:
Bile duct
Colon and rectum
Stomach
Ovaries
Bladder
During cancer treatment, your health care provider may test you on a regular basis to see if your treatment is working.
After your treatment is complete, you may need to have CA 19-9 tests to check whether the cancer has come back. High levels of CA 19-9 may be one of the first signs that cancer cells are growing again.
A health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.
Usually, you don't need any special preparations for a CA 19-9 blood test. But ask your provider to be sure. If you take certain vitamins, you may need to stop them before the test.
There is very little risk to having a blood test. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.
If you're being treated for cancer, you may be tested several times during your treatment. Your provider will look at all your test results to see how your CA 19-9 levels have changed. Your results may show:
Your levels of CA 19-9 are increasing. This may mean your tumor is growing, and/or your treatment is not working. More tests are usually needed to find out for sure.
Your levels of CA 19-9 are decreasing. This may mean your tumor is shrinking and your treatment is working.
Your levels of CA 19-9 have stayed the same. This may mean your disease is stable and hasn't gotten better or worse.
Your CA 19-9 levels decreased after treatment, but increased later. This may mean your cancer has come back or grown. You'll need more tests to check whether cancer is really causing the higher level of CA 19-9.
If you don't have cancer but your test results show a high level of CA 19-9, you may not a health problem that needs treatment. Healthy people can have high CA 19-9 levels. But high levels may be a sign of a condition, such as:
Pancreatitis, inflammation of the pancreas
Gallstones
Bile duct disease, including a blockage or infection
Liver disease
Cystic fibrosis
Talk with your provider about what your results may mean.
If your provider thinks you may have one of these conditions, you will probably need other tests to find out for sure.
Labs use different methods to measure the amount of CA 19-9 in your blood sample. The test method can affect your results. If you're having regular tests to monitor cancer, it's important to have your tests done the same way, and usually in the same lab. This allows your provider to compare your results over time. Your test report usually says what method was used to measure your CA 19-9 levels. If you have any questions about how your tests are done, talk with your provider.
CA 19-9 Blood Test (Pancreatic Cancer): MedlinePlus Lab Test Information [accessed on Nov 05, 2018]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Additional Materials (7)
Pancreatic Cancer
Pancreatic Cancer: In Situ : The summary staging system categorizes cancer (shown here in the pancreas) according to its spread. In situ cancer is present only in cells in which it began.
Image by TheVisualMD
Amylase, Pancreatic Cancer
Amylase is one of several enzymes produced by the pancreas and secreted into the digestive tract to help break down nutrients (amylase is also produced by the salivary glands). The enzyme is usually present in the blood and urine only in small quantities, but when pancreatic tissue is injured, inflamed (pancreatitis) or when the pancreatic duct is blocked or a tumor is present, amylase can leak into the blood and urine. As cancerous tissue overwhelms the pancreas, its function is compromised and enzyme levels fall.
Image by TheVisualMD
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Pancreas joined to the small bowel after pylorus preserving surgery for pancreatic cancer
Diagram showing the pancreas joined to the small bowel after pylorus preserving surgery for pancreatic cancer
Image by Cancer Research UK / Wikimedia Commons
Pancreatic Cancer
Cancer Types _ Pancreatic Cancer Cells or Tissue _ Abnormal Cells or Tissue
Image by Dr. Lance Liotta Laboratory _ NCI
Doctor explains Ca 19-9 blood test used in PANCREATIC CANCER | LAB TESTS explained
Video by Doctor O'Donovan/YouTube
Diagnosing Pancreatic Tumors and Cysts - Mayo Clinic
Video by Mayo Clinic/YouTube
T1 stage - the tumor is inside the pancreas and is 2cm or less in any direction.
T2 stage - the cancer is more than 2cm but no more than 4cm in size in any direction.
T3 stage - the cancer is more than 4cm in size.
T4 stage - the cancer has grown outside the pancreas, into the nearby large blood vessels.
Node (N) describes whether the cancer has spread to the lymph nodes. It is further divided into N0 and N1 stages.
Metastasis (M) describes whether the cancer has spread to a different part of the body. It is further divided into M0 and M1 stages.
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TNM Staging for Pancreatic Cancer
TNM stands for Tumour, Node, Metastasis. This system describes the size of a primary tumour (T), whether there are lymph nodes with cancer cells in them (N) and whether the cancer has spread to a different part of the body (M).
Interactive by Cancer Research UK
Pancreatic Cancer
TheVisualMD
Amylase, Pancreatic Cancer
TheVisualMD
Sensitive content
This media may include sensitive content
Pancreas joined to the small bowel after pylorus preserving surgery for pancreatic cancer
Cancer Research UK / Wikimedia Commons
Pancreatic Cancer
Dr. Lance Liotta Laboratory _ NCI
5:17
Doctor explains Ca 19-9 blood test used in PANCREATIC CANCER | LAB TESTS explained
Doctor O'Donovan/YouTube
5:55
Diagnosing Pancreatic Tumors and Cysts - Mayo Clinic
Mayo Clinic/YouTube
TNM Staging for Pancreatic Cancer
Cancer Research UK
Abdominal Ultrasound
Abdominal Ultrasound
Also called: Ultrasound - abdomen, Abdominal sonogram, Abdominal sonography, Right upper quadrant sonogram, Ultrasound of the Abdomen, Ultrasound Imaging of the Abdomen
An abdominal ultrasound uses sound waves to look at organs in the abdomen, including the liver, gallbladder, spleen, pancreas, and kidneys. It may also be used to assess blood flow to abdominal organs. An abdominal ultrasound can help find the cause of stomach pain or bloating, check for kidney stones, liver disease, tumors and many other conditions.
Abdominal Ultrasound
Also called: Ultrasound - abdomen, Abdominal sonogram, Abdominal sonography, Right upper quadrant sonogram, Ultrasound of the Abdomen, Ultrasound Imaging of the Abdomen
An abdominal ultrasound uses sound waves to look at organs in the abdomen, including the liver, gallbladder, spleen, pancreas, and kidneys. It may also be used to assess blood flow to abdominal organs. An abdominal ultrasound can help find the cause of stomach pain or bloating, check for kidney stones, liver disease, tumors and many other conditions.
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Use the slider below to see how your results affect your
health.
Your result is Normal.
A normal result indicates that the organs examined appear normal.
Related conditions
https://www.niddk.nih.gov/health-information/diagnostic-tests/prostate#additional [accessed on Sep 16, 2019]
https://www.niddk.nih.gov/health-information/digestive-diseases/appendicitis/diagnosis [accessed on Sep 19, 2019]
https://www.niddk.nih.gov/health-information/diagnostic-tests/urinary-tract-imaging [accessed on Sep 16, 2019]
https://www.niddk.nih.gov/health-information/urologic-diseases/urine-blockage-newborns/vesicoureteral-reflux [accessed on Sep 16, 2019]
https://medlineplus.gov/ency/article/003777.htm [accessed on Oct 09, 2021]
https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/abdominal-ultrasound [accessed on Oct 09, 2021]
https://www.radiologyinfo.org/en/info/abdominus [accessed on Oct 09, 2021]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Laparoscopy
Laparoscopy
Also called: Diagnostic Laparoscopy, Exploratory Laparoscopy
A laparoscopy is surgery that lets a surgeon see your organs without making a large cut in your body. It is used to diagnose and treat conditions that develop in your belly or pelvis.
Laparoscopy
Also called: Diagnostic Laparoscopy, Exploratory Laparoscopy
A laparoscopy is surgery that lets a surgeon see your organs without making a large cut in your body. It is used to diagnose and treat conditions that develop in your belly or pelvis.
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Use the slider below to see how your results affect your
health.
Your result is Normal.
A normal result means that the examined site was found to have a normal shape and size, without any abnormal masses or tissues.
Related conditions
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Use the slider below to see how your results affect your
health.
Your result is Normal.
In the normal pelvis, the uterus, tubes and ovaries are gleaming with health. Neither the tubes nor the ovaries should be stuck down by adhesions or any other abnormalities.
Related conditions
A laparoscopy is a type of surgery that lets a surgeon look inside your body without making a large incision (cut). It's used to help diagnose and sometimes treat conditions that develop in your belly or pelvis.
To do a laparoscopy, a surgeon makes a small cut near your belly button that's usually a half-inch long or less. The surgeon inserts a long, thin tube with a camera through the cut and into your body. This tube is called a laparoscope. The camera sends images from inside your body to a video monitor. This allows the surgeon to see inside your body.
The surgeon may make one or two other small cuts in your belly for inserting special surgical tools into your body. Using these tools, the surgeon can remove samples of tissue to check for signs of disease (a biopsy).
Sometimes during a laparoscopy, the surgeon will use these tools to do procedures to treat certain problems. For example, if a laparoscopy finds a tumor, the surgeon may remove it completely during the same surgery. Many common surgical treatments can be done with laparoscopic surgery.
Laparoscopy is sometimes called "minimally invasive surgery" or "keyhole surgery," because it requires smaller cuts than traditional, "open" surgery. The use of smaller cuts has several benefits, including:
Shorter hospital stays
Less pain
Faster recovery and smaller scars
Laparoscopy is used to help diagnose the cause of symptoms in the belly or pelvis. It's usually done if imaging tests, such as x-rays, ultrasounds, and MRI scans, haven't provided enough information to confirm a diagnosis.
The test is often used to help diagnose:
Digestive diseases
Urinary disorders
Disorders in the female reproductive system, which includes the uterus, ovaries, and fallopian tubes
A surgeon uses laparoscopy to:
Examine organs and glands to look for:
Abnormal growths, such as cysts and tumors (cancerous and not cancerous)
Scar tissue and adhesions
Bleeding
Infections
Collect tissue samples to check for disease
Find out if a known cancer has spread in the body
There are many reasons why you may need a laparoscopy, including if:
You have pain or other symptoms in your belly or pelvis and imaging tests haven't been able to find the cause.
You've been in a serious accident or have been wounded and may have organ injuries.
You have cancer and your health care provider needs to know if it has spread to other parts of your body. This information helps choose your treatment.
You've had abnormal liver tests and your provider doesn't know why.
If you're female, you may need a laparoscopy to:
Find out what's causing problems getting pregnant
Diagnose symptoms that may involve your reproductive organs, including:
Pelvic inflammatory disease (PID)
Endometriosis
Ectopic pregnancy
Uterine fibroids
Ovarian cysts
Laparoscopy is usually done in a hospital or an outpatient clinic. In general, it includes these steps:
You'll wear a hospital gown and lay on an operating table.
Usually, you will have general anesthesia, which is medicine to make you sleep during the surgery. The medicine is injected into your bloodstream through an intravenous (IV) line that's inserted into a vein. You may also inhale a gas from a mask to make you sleep.
To do the laparoscopy, the surgeon will:
Make a small cut near your belly button
Put carbon dioxide gas into your belly to open up space between your organs so it's easier to see them
Insert the laparoscope and small camera into your belly
Move the laparoscope to look at your organs and glands on a computer screen
If you need to have a biopsy or another procedure, the surgeon may need to make more small cuts to insert surgical tools.
When the surgeon is done, the tools and most of the gas will be removed from your body, and the small incisions will be closed and bandaged.
After surgery, you will be moved to a recovery room. In most cases, you'll be able to go home after a few hours, but that depends on what procedures were done during the laparoscopy. Before you leave, you'll get information about what to expect over the next few days at home.
Your provider will let you know how to prepare. Be sure to follow all the instructions. You will need to fast (not eat or drink) for a period of time before a laparoscopy. Ask your provider whether you should take your usual medicines and/or supplements. But don't stop taking any medicine without talking with your provider first.
Plan to wear loose-fitting clothes because after the surgery, your belly may be bloated from the gas and a little sore. You're also likely to feel groggy, so you'll need to plan to have someone take you home.
You may have mild abdominal pain or discomfort for a few days after a laparoscopy. You may also have neck or shoulder pain. That's because the gas used in the surgery may irritate nerves in your belly that run through your shoulder.
After a laparoscopy, serious problems are very uncommon. But they can include bleeding, infection, blood clots, damage to an organ or blood vessel, and problems from the medicine that made you sleep during the procedure.
The results of a laparoscopy depend on the reason for doing the procedure. Your provider can explain what was found and what that information means for your health. In general, your provider will be able to make a very accurate diagnosis of your condition based on the information from a laparoscopy.
Laparoscopy: MedlinePlus Medical Test [accessed on Mar 09, 2023]
Diagnostic laparoscopy: MedlinePlus Medical Encyclopedia [accessed on Dec 21, 2018]
Pelvic Laparoscopy: Purpose, Procedure, and Recovery [accessed on Dec 20, 2018]
Female Pelvic Laparoscopy Procedure | Cleveland Clinic [accessed on Dec 20, 2018]
Gynecologic Laparoscopy: Purpose, Procedure, and Risks [accessed on Dec 20, 2018]
Laparoscopy: Purpose, Preparation, Procedure, and Recovery [accessed on Dec 20, 2018]
Laparoscopic Surgery: Purpose, Procedure, and Benefits [accessed on Dec 20, 2018]
https://www.acog.org/~/media/For%20Patients/faq136.pdf [accessed on Dec 20, 2018]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Additional Materials (12)
Anti-Reflux Laparoscopy Heartburn Surgery Medical PreOp® Patient Education
Video by PreOp.com Patient Engagement - Patient Education/YouTube
Sleeve Gastrectomy at Duke Center for Metabolic and Weight Loss Surgery
Video by Duke Health/YouTube
Gallstones and Surgical Removal of Gallbladder (Cholecystectomy) Animation.
Video by Alila Medical Media/YouTube
Surgeon Performing Laparoscopic Kidney Transplant
This photograph shows the posterior view of two surgeons performing laparoscopic kidney transplant surgery with a view of the patient's abdomen on the monitor. Laparoscopy is a a minimally invasive procedure which requires only small incisions and has replaced conventional operations for kidney removal that used to require a larger opening and therefore longer recovery time. The procedure for living donors involves inserting a special needle into the abdominal cavity to fill it up with gas and create space. A metal tube with a camera, called a laparoscope, is inserted through a two-inch incision in the skin. Surgical instruments can be inserted through the laparoscope, and the surgeon can watch his progress in removing the kidney on a video monitor above the patient. With laparoscopic surgery, donors feel less pain after the transplant, and are able to return to their daily routine sooner.
Image by TheVisualMD
Laparoscopic stomach surgery
Doctors Ronald Post (left) and John Smear (center) and Physician's Assistant Debra Blackshire perform laparoscopic stomach surgery at Langley Air Force Base, Va., on Jan. 31, 2005. The surgery will involve the removal of the gall bladder to help alleviate acid reflux disease.
Image by Samuel Bendet, US Air Force
Illustration of Laparoscopy
Laparoscopy (from Ancient Greek λαπάρα (lapara), meaning 'flank, side', and σκοπέω (skopeo), meaning 'to see') is an operation performed in the abdomen or pelvis using small incisions (usually 0.5–1.5 cm) with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen.
Image by Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436.
Laparoscopic Cholecystectomy
X-ray of organs during a laprasopic cholecystectomy. The picture shows the liver on top, the biliary tree within the liver, and the cystic duct going from the gall bladder to the common bile duct, which then goes down to duodenum.
Sleeve Gastrectomy at Duke Center for Metabolic and Weight Loss Surgery
Duke Health/YouTube
3:06
Gallstones and Surgical Removal of Gallbladder (Cholecystectomy) Animation.
Alila Medical Media/YouTube
Surgeon Performing Laparoscopic Kidney Transplant
TheVisualMD
Laparoscopic stomach surgery
Samuel Bendet, US Air Force
Illustration of Laparoscopy
Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436.
Laparoscopic Cholecystectomy
HenrikP
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Uterus
Hic et nunc
Sleeve Gastrectomy
Stevenfruitsmaak at en.wikipedia derivative work: Jan Friberg (talk)
Laparoscopic Surgery (Keyhole Surgery)
U.S. Navy photo by Mass Communication Specialist Seaman Paul Polach
Abdominal Quadrant Regions
OpenStax College
Ultrasound of Pelvis and Abdomen
TheVisualMD
Magnetic Resonance Cholangiopancreatography
Magnetic resonance cholangiopancreatography (MRCP)
Image by Samir
Magnetic resonance cholangiopancreatography (MRCP)
image of patient with two stones in distal en:common bile duct
Image by Samir
Magnetic Resonance Cholangiopancreatography
Non-invasive diagnostic technique for visualizing the PANCREATIC DUCTS and BILE DUCTS without the use of injected CONTRAST MEDIA or x-ray. MRI scans provide excellent sensitivity for duct dilatation, biliary stricture, and intraductal abnormalities.
Source: National Center for Biotechnology Information (NCBI)
Additional Materials (7)
Magnetic resonance cholangiopancreatography (MRCP)
MRCP image showing stones in the distal common bile duct: (a) Gallbladder with stones, (b) Stones in bile duct, (c) Pancreatic duct, (d) Duodenum.
Image by Hellerhoff
MRCP of Caroli disease
Magnetic resonance cholangiopancreatography (MRCP) of the liver of a 27 year old woman with Caroli disease. Multiple cystic lesions in the left liver lobe. Saccular ectasia of the main biliary duct is also depicted.
Image by Simone Maurea, Carmine Mollica, Massimo Imbriaco, Mario Fusari, Luigi Camera, Marco Salvatore/Wikimedia
Magnetic resonance cholangiopancreatography (MRCP)
Magnetic resonance cholangiopancreatography of a pancreatic divisum: (a) gall bladder, (b) bile duct crossing the (c) long duct of Santorini, (d) a short pancreatic duct together with the bile duct on the major duodenal papilla, (e) imaged with renal collecting system.
Image by Hellerhoff
Endoscopic retrograde cholangiopancreatography
Fluoroscopic image showing dilatation of the pancreatic duct during ERCP investigation. Endoscope is visible.
Image by DrM!KEY
When are MRCP and ERCP used for diagnosis of chronic pancreatitis?
Video by Animated Pancreas Patient/YouTube
MRCP Test | MRI Scan For Pancreas | MRCP Test Price |
Video by BMH learning/YouTube
Mrcp Magnetic resonance cholangiopancreatography (MRCP)
Video by MRI TIPS/YouTube
Magnetic resonance cholangiopancreatography (MRCP)
Hellerhoff
MRCP of Caroli disease
Simone Maurea, Carmine Mollica, Massimo Imbriaco, Mario Fusari, Luigi Camera, Marco Salvatore/Wikimedia
Magnetic resonance cholangiopancreatography (MRCP)
Hellerhoff
Endoscopic retrograde cholangiopancreatography
DrM!KEY
1:37
When are MRCP and ERCP used for diagnosis of chronic pancreatitis?
Animated Pancreas Patient/YouTube
1:28
MRCP Test | MRI Scan For Pancreas | MRCP Test Price |
BMH learning/YouTube
1:54
Mrcp Magnetic resonance cholangiopancreatography (MRCP)
MRI TIPS/YouTube
Stages
Type 1 – the cancer is in the hepatic duct.
Type 2 – the cancer is in the hepatic duct and the junction where the left and right hepatic bile ducts meet.
Type 3A – the cancer is in the hepatic duct, the junction where the left and right bile ducts meet, and in the right hepatic duct.
Type 3B – the cancer is in the hepatic duct, the junction where the left and right bile ducts meet, and in the left hepatic duct.
Type 4 – the cancer is in the hepatic duct, the junction where the left and right bile ducts meet, and in both left and right hepatic ducts.
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Bismuth-Corlette Staging for Perihilar Cancers
Interactive by Cancer Research UK
Type 1 – the cancer is in the hepatic duct.
Type 2 – the cancer is in the hepatic duct and the junction where the left and right hepatic bile ducts meet.
Type 3A – the cancer is in the hepatic duct, the junction where the left and right bile ducts meet, and in the right hepatic duct.
Type 3B – the cancer is in the hepatic duct, the junction where the left and right bile ducts meet, and in the left hepatic duct.
Type 4 – the cancer is in the hepatic duct, the junction where the left and right bile ducts meet, and in both left and right hepatic ducts.
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Bismuth-Corlette Staging for Perihilar Cancers
The Bismuth-Corlette staging system divides perihilar cancers into 4 main types. The type you have depends on where the cancer is in the perihilar area. Type 1 – the cancer is in the hepatic duct. Type 2 – the cancer is in the hepatic duct and the junction where the left and right hepatic bile ducts meet. Type 3A – the cancer is in the hepatic duct, the junction where the left and right bile ducts meet, and in the right hepatic duct. Type 3B – the cancer is in the hepatic duct, the junction where the left and right bile ducts meet, and in the left hepatic duct. Type 4 – the cancer is in the hepatic duct, the junction where the left and right bile ducts meet, and in both left and right hepatic ducts.
Interactive by Cancer Research UK
Stages of Bile Duct Cancer
The results of diagnostic and staging tests are used to find out if cancer cells have spread.
The process used to find out if cancer has spread to other parts of the body is called staging. For bile duct cancer, the information gathered from tests and procedures is used to plan treatment, including whether the tumor can be removed by surgery.
There are three ways that cancer spreads in the body.
Cancer can spread through tissue, the lymph system, and the blood:
Tissue. The cancer spreads from where it began by growing into nearby areas.
Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.
Cancer may spread from where it began to other parts of the body.
When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.
Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.
The metastatic tumor is the same type of cancer as the primary tumor. For example, if bile duct cancer spreads to the liver, the cancer cells in the liver are actually bile duct cancer cells. The disease is metastatic bile duct cancer, not liver cancer.
Stages are used to describe the different types of bile duct cancer.
Intrahepatic bile duct cancer
Stage 0: In stage 0 intrahepatic bile duct cancer, abnormal cells are found in the innermost layer of tissue lining the intrahepatic bile duct. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.
Stage I: Stage I intrahepatic bile duct cancer is divided into stages IA and IB.Tumor sizes are often measured in centimeters (cm) or inches. Common food items that can be used to show tumor size in cm include: a pea (1 cm), a peanut (2 cm), a grape (3 cm), a walnut (4 cm), a lime (5 cm or 2 inches), an egg (6 cm), a peach (7 cm), and a grapefruit (10 cm or 4 inches).
In stage IA, cancer has formed in an intrahepatic bile duct and the tumor is 5 centimeters or smaller.
In stage IB, cancer has formed in an intrahepatic bile duct and the tumor is larger than 5 centimeters.
Stage II: In stage II intrahepatic bile duct cancer, either of the following is found:
the tumor has spread through the wall of an intrahepatic bile duct and into a blood vessel; or
more than one tumor has formed in the intrahepatic bile duct and may have spread into a blood vessel.
Stage III: Stage III intrahepatic bile duct cancer is divided into stages IIIA and IIIB.
In stage IIIA, the tumor has spread through the capsule (outer lining) of the liver.
In stage IIIB, cancer has spread to organs or tissues near the liver, such as the duodenum, colon, stomach, common bile duct, abdominal wall, diaphragm, or the part of the vena cava behind the liver, or the cancer has spread to nearby lymph nodes.
Stage IV: In stage IV intrahepatic bile duct cancer, cancer has spread to other parts of the body, such as the bone, lungs, distant lymph nodes, or tissue lining the wall of the abdomen and most organs in the abdomen.
Perihilar bile duct cancer
Stage 0: In stage 0 perihilar bile duct cancer, abnormal cells are found in the innermost layer of tissue lining the perihilar bile duct. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ or high-grade dysplasia.
Stage I: In stage I perihilar bile duct cancer, cancer has formed in the innermost layer of tissue lining the perihilar bile duct and has spread into the muscle layer or fibrous tissue layer of the perihilar bile duct wall.
Stage II: In stage II perihilar bile duct cancer, cancer has spread through the wall of the perihilar bile duct to nearby fatty tissue or to liver tissue.
Stage III: Stage III perihilar bile duct cancer is divided into stages IIIA, IIIB, and IIIC.
Stage IIIA: cancer has spread to branches on one side of the hepatic artery or of the portal vein.
Stage IIIB: cancer has spread to one or more of the following:
the main part of the portal vein or its branches on both sides;
the common hepatic artery;
the right hepatic duct and the left branch of the hepatic artery or of the portal vein;
the left hepatic duct and the right branch of the hepatic artery or of the portal vein.
Stage IIIC: cancer has spread to 1 to 3 nearby lymph nodes.
Stage IV: Stage IV perihilar bile duct cancer is divided into stages IVA and IVB.
Stage IVA: Cancer has spread to 4 or more nearby lymph nodes.
Stage IVB: Cancer has spread to other parts of the body, such as the liver, lung, bone, brain, skin, distant lymph nodes, or tissue lining the wall of the abdomen and most organs in the abdomen.
Distal bile duct cancer
Stage 0: In stage 0 distal bile duct cancer, abnormal cells are found in the innermost layer of tissue lining the distal bile duct. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ or high-grade dysplasia.Millimeters (mm). A sharp pencil point is about 1 mm, a new crayon point is about 2 mm, and a new pencil eraser is about 5 mm.
Stage I: In stage I distal bile duct cancer, cancer has formed and spread fewer than 5 millimeters into the wall of the distal bile duct.
Stage II: Stage II distal bile duct cancer is divided into stages IIA and IIB.
Stage IIA: Cancer has spread:
fewer than 5 millimeters into the wall of the distal bile duct and has spread to 1 to 3 nearby lymph nodes; or
5 to 12 millimeters into the wall of the distal bile duct.
Stage IIB: Cancer has spread 5 millimeters or more into the wall of the distal bile duct. Cancer may have spread to 1 to 3 nearby lymph nodes.
Stage III: Stage III distal bile duct cancer is divided into stages IIIA and IIIB.
Stage IIIA: Cancer has spread into the wall of the distal bile duct and to 4 or more nearby lymph nodes.
Stage IIIB: Cancer has spread to the large vessels that carry blood to the organs in the abdomen. Cancer may have spread to 1 or more nearby lymph nodes.
Stage IV: In stage IV distal bile duct cancer, cancer has spread to other parts of the body, such as the liver, lungs, or tissue lining the wall of the abdomen and most organs in the abdomen.
The following groups are used to plan treatment:
Resectable (localized) bile duct cancer
The cancer is in an area, such as the lower part of the common bile duct or perihilar area, where it can be removed completely by surgery.
Unresectable (including metastatic and recurrent) bile duct cancer
Unresectable cancer cannot be removed completely by surgery. Most patients with bile duct cancer cannot have their cancer completely removed by surgery.
Metastasis is the spread of cancer from the primary site (place where it started) to other places in the body. Metastatic bile duct cancer may have spread to the liver, other parts of the abdominal cavity, or to distant parts of the body.
Recurrent bile duct cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the bile ducts, liver, or gallbladder. Less often, it may come back in distant parts of the body.
Source: National Cancer Institute (NCI)
Additional Materials (2)
Bismuth corlette classification for perihilar cholangiocarcinomas
This is a derivative work combining 5 SVGs illustrating the Bismuth Corlette Classification originally uploaded by User:Cancer Research UK uploader under CC 4.0
Image by Jaax/Wikimedia
The gallbladder and bile ducts | Cancer Research UK
Video by Cancer Research UK/YouTube
Bismuth corlette classification for perihilar cholangiocarcinomas
Jaax/Wikimedia
1:27
The gallbladder and bile ducts | Cancer Research UK
Cancer Research UK/YouTube
Treatment
Whipple Surgery (Close Up)
Image by BruceBlaus/Wikimedia
Whipple Surgery (Close Up)
A medical illustration depicting the Whipple procedure.
Image by BruceBlaus/Wikimedia
Treatment Option Overview for Bile Duct Cancer
There are different types of treatment for patients with bile duct cancer.
Different types of treatments are available for patients with bile duct cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Three types of standard treatment are used:
Surgery
The following types of surgery are used to treat bile duct cancer:
Removal of the bile duct: A surgical procedure to remove part of the bile duct if the tumor is small and in the bile duct only. Lymph nodes are removed and tissue from the lymph nodes is viewed under a microscope to see if there is cancer.
Partial hepatectomy: A surgical procedure in which the part of the liver where cancer is found is removed. The part removed may be a wedge of tissue, an entire lobe, or a larger part of the liver, along with some normal tissue around it.
Whipple procedure: A surgical procedure in which the head of the pancreas, the gallbladder, part of the stomach, part of the small intestine, and the bile duct are removed. Enough of the pancreas is left to make digestive juices and insulin.
After the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy. It is not yet known whether chemotherapy or radiation therapy given after surgery helps keep the cancer from coming back.
The following types of palliative surgery may be done to relieve symptoms caused by a blocked bile duct and improve quality of life:
Biliary bypass: If cancer is blocking the bile duct and bile is building up in the gallbladder, a biliary bypass may be done. During this operation, the doctor will cut the gallbladder or bile duct in the area before the blockage and sew it to the part of the bile duct that is past the blockage or to the small intestine to create a new pathway around the blocked area.
Endoscopic stent placement: If the tumor is blocking the bile duct, surgery may be done to put in a stent (a thin tube) to drain bile that has built up in the area. The doctor may place the stent through a catheter that drains the bile into a bag on the outside of the body or the stent may go around the blocked area and drain the bile into the small intestine.
Percutaneous transhepatic biliary drainage: A procedure used to x-ray the liver and bile ducts. A thin needle is inserted through the skin below the ribs and into the liver. Dye is injected into the liver or bile ducts and an x-ray is taken. If the bile duct is blocked, a thin, flexible tube called a stent may be left in the liver to drain bile into the small intestine or a collection bag outside the body.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:
External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer.
Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.
External and internal radiation therapy are used to treat bile duct cancer.
It is not yet known whether external radiation therapy helps in the treatment of resectable bile duct cancer. In unresectable, metastatic, or recurrent bile duct cancer, new ways to improve the effect of external radiation therapy on cancer cells are being studied:
Hyperthermia therapy: A treatment in which body tissue is exposed to high temperatures to make cancer cells more sensitive to the effects of radiation therapy and certain anticancer drugs.
Radiosensitizers: Drugs that make cancer cells more sensitive to radiation therapy. Combining radiation therapy with radiosensitizers may kill more cancer cells.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).
Systemic chemotherapy is used to treat unresectable, metastatic, or recurrent bile duct cancer. It is not yet known whether systemic chemotherapy helps in the treatment of resectable bile duct cancer.
In unresectable, metastatic, or recurrent bile duct cancer, intra-arterial embolization is being studied. It is a procedure in which the blood supply to a tumor is blocked after anticancer drugs are given in blood vessels near the tumor. Sometimes, the anticancer drugs are attached to small beads that are injected into an artery that feeds the tumor. The beads block blood flow to the tumor as they release the drug. This allows a higher amount of drug to reach the tumor for a longer period of time, which may kill more cancer cells.
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website.
Liver transplant
In a liver transplant, the entire liver is removed and replaced with a healthy donated liver. A liver transplant may be done in patients with perihilar bile duct cancer. If the patient has to wait for a donated liver, other treatment is given as needed.
Targeted therapy
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do. The following targeted therapies are being studied in patients with bile duct cancer that is locally advanced and cannot be removed by surgery or has spread to other parts of the body:
Ivosidenib is a type of targeted therapy that blocks a specific mutation in a gene called IDH1. It works by slowing or stopping the growth of cancer cells.
Pemigatinib and infigratinib are types of targeted therapies that block specific changes in a gene called FGFR2. This may help keep cancer cells from growing and may kill them.
Immunotherapy
Immunotherapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This cancer treatment is a type of biologic therapy.
Immune checkpoint inhibitor therapy is a type of immunotherapy that may be used to treat bile duct cancer.
PD-1 and PD-L1 inhibitor therapy: PD-1 is a protein on the surface of T cells that helps keep the body’s immune responses in check. PD-L1 is a protein found on some types of cancer cells. When PD-1 attaches to PD-L1, it stops the T cell from killing the cancer cell. PD-1 and PD-L1 inhibitors keep PD-1 and PD-L1 proteins from attaching to each other. This allows the T cells to kill cancer cells. Pembrolizumab is a type of PD-1 inhibitor that may be used in patients whose cancer is locally advanced and cannot be removed by surgery or has spread to other parts of the body.
Immune checkpoint inhibitor. Checkpoint proteins, such as PD-L1 on tumor cells and PD-1 on T cells, help keep immune responses in check. The binding of PD-L1 to PD-1 keeps T cells from killing tumor cells in the body (left panel). Blocking the binding of PD-L1 to PD-1 with an immune checkpoint inhibitor (anti-PD-L1 or anti-PD-1) allows the T cells to kill tumor cells (right panel).
Treatment for bile duct cancer may cause side effects.
For information about side effects caused by treatment for cancer, see our Side Effects page.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
Source: National Cancer Institute (NCI)
Additional Materials (3)
Liver tumor types in adults by relative incidence
Liver tumor types by relative incidence in adults in the United States. Reference:
Table 37.2 in: Sternberg, Stephen (2012) Sternberg's diagnostic surgical pathology, LWW ISBN: 978-1-4511-5289-0. OCLC: 953861627.
Image by
Mikael Häggström, M.D. - Author info - Reusing images- Conflicts of interest: None
Mikael Häggström/Wikimedia
Bile duct cancer treatment hope
Video by The University of Edinburgh/YouTube
Navigating the Clinical Trials Maze: Bile Duct Cancer
Video by TheBiliProject/YouTube
Liver tumor types in adults by relative incidence
Mikael Häggström, M.D. - Author info - Reusing images- Conflicts of interest: None
Mikael Häggström/Wikimedia
3:27
Bile duct cancer treatment hope
The University of Edinburgh/YouTube
5:41
Navigating the Clinical Trials Maze: Bile Duct Cancer
Treatment of resectable intrahepatic bile duct cancer may include:
Surgery to remove the cancer, which may include partial hepatectomy. Embolization may be done before surgery.
Surgery followed by chemotherapy and/or radiation therapy.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
Unresectable, Recurrent, or Metastatic Intrahepatic Bile Duct Cancer
Treatment of unresectable, recurrent, or metastatic intrahepatic bile duct cancer may include the following:
Stent placement as palliative treatment to relieve symptoms and improve quality of life.
External or internal radiation therapy as palliative treatment to relieve symptoms and improve the quality of life.
Chemotherapy.
A clinical trial of external radiation therapy combined with hyperthermia therapy, radiosensitizer drugs, or chemotherapy.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
Perihilar Bile Duct Cancer
Resectable Perihilar Bile Duct Cancer
Treatment of resectable perihilar bile duct cancer may include the following:
Surgery to remove the cancer, which may include partial hepatectomy.
Stent placement or percutaneous transhepatic biliary drainage as palliative therapy, to relieve jaundice and other symptoms and improve the quality of life.
Surgery followed by radiation therapy and/or chemotherapy.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
Unresectable, Recurrent, or Metastatic Perihilar Bile Duct Cancer
Treatment of unresectable, recurrent, or metastatic perihilar bile duct cancer may include the following:
Stent placement or biliary bypass as palliative treatment to relieve symptoms and improve the quality of life.
External or internal radiation therapy as palliative treatment to relieve symptoms and improve the quality of life.
Chemotherapy.
A clinical trial of external radiation therapy combined with hyperthermia therapy, radiosensitizer drugs, or chemotherapy.
A clinical trial of chemotherapy and radiation therapy followed by a liver transplant.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
Distal Extrahepatic Bile Duct Cancer
Resectable Distal Extrahepatic Bile Duct Cancer
Treatment of resectable distal extrahepatic bile duct cancer may include the following:
Surgery to remove the cancer, which may include a Whipple procedure.
Stent placement or percutaneous transhepatic biliary drainage as palliative therapy, to relieve jaundice and other symptoms and improve the quality of life.
Surgery followed by radiation therapy and/or chemotherapy.
Unresectable, Recurrent, or Metastatic Distal Extrahepatic Bile Duct Cancer
Treatment of unresectable, recurrent, or metastatic distal extrahepatic bile duct cancer may include the following:
Stent placement or biliary bypass as palliative treatment to relieve symptoms and improve the quality of life.
External or internal radiation therapy as palliative treatment to relieve symptoms and improve the quality of life.
Chemotherapy.
A clinical trial of external radiation therapy combined with hyperthermia therapy, radiosensitizer drugs, or chemotherapy.
Source: National Cancer Institute (NCI)
Additional Materials (3)
AORC” nomenclature framework for CE surgery.
“AORC” nomenclature framework for CE surgery.
(A) (top) – Vocabulary and acronyms. AORC: acronym for Approach, Opening, Resection and Completeness; CE: cystic echinococcosis; OC: opened cyst; NOC: non-opened cyst.
(B) (bottom) –
A. Schematic structure of CE cyst: the CE cyst consists (from inside to outside) of the germinal layer, laminated layer and adventitial layer.
B. Total cystectomy requires the resection of all three layers completely.
C. Subtotal cystectomy requires the nearly total resection of all three layers; only parts of the adventitial layer are preserved because of surgical safety.
D. Partial cystectomy refers to the incomplete resection of any of three layers (usually of the adventitial layer) due to technical and safety issue.
E. Hepatectomy requires the en bloc resection of part of liver parenchyma, following the rules of hepatic resection.
Image by Dominique A. Vuitton, Donald P. McManus, Thomas Romig, Michael R. Rogan, Bruno Gottstein, Antonio Menezes da Silva, Hao Wen, Ariel Naidich, Tuerhongjiang Tuxun, Amza Avcioglu, Belgees Boufana, Christine Budke, Adriano Casulli, Esin Güven, Andreas Hillenbrand, Fateme Jalousian, Mohamed Habib Jemli, Jenny Knapp, Abdelkarim Laatamna, Samia Lahmar, Ariel Naidich, Michael T. Rogan, Seyed Mahmoud Sadjjadi, Julian Schmidberger, Manel Amri, Anne-Pauline Bellanger, Sara Benazzouz, Klaus Brehm, Andreas Hillenbrand, Fateme Jalousian, Malika Kachani, Moussa Labsi, Giovanna Masala, Antonio Menezes da Silva, Mahmoud Sadjjadi Seyed, Imene Soufli, Chafia Touil-Boukoffa, Junhua Wang, Eberhard Zeyhle, Tuerganaili Aji, Okan Akhan, Solange Bresson-Hadni, Chadli Dziri, Tilmann Gräter, Beate Grüner, Assia Haïf, Andreas Hillenbrand, Stéphane Koch, Michael T. Rogan, Francesca Tamarozzi, Tuerhongjiang Tuxun, Patrick Giraudoux, Paul Torgerson, Katherina Vizcaychipi, Ning Xiao, Nazmiye Altintas, Renyong Lin, Laurence Millon, Wenbao Zhang, Karima Achour, Haining Fan, Thomas Junghanss and Georges A. Mantion/Wikimedia
3D Medical Animation liver parts
3D medical illustration showing hepatic hilum,hepatic artery, portal vein.
Image by https://www.scientificanimations.com
Bile Duct Cancer: A patient's journey
Video by Dana-Farber Cancer Institute/YouTube
AORC” nomenclature framework for CE surgery.
Dominique A. Vuitton, Donald P. McManus, Thomas Romig, Michael R. Rogan, Bruno Gottstein, Antonio Menezes da Silva, Hao Wen, Ariel Naidich, Tuerhongjiang Tuxun, Amza Avcioglu, Belgees Boufana, Christine Budke, Adriano Casulli, Esin Güven, Andreas Hillenbrand, Fateme Jalousian, Mohamed Habib Jemli, Jenny Knapp, Abdelkarim Laatamna, Samia Lahmar, Ariel Naidich, Michael T. Rogan, Seyed Mahmoud Sadjjadi, Julian Schmidberger, Manel Amri, Anne-Pauline Bellanger, Sara Benazzouz, Klaus Brehm, Andreas Hillenbrand, Fateme Jalousian, Malika Kachani, Moussa Labsi, Giovanna Masala, Antonio Menezes da Silva, Mahmoud Sadjjadi Seyed, Imene Soufli, Chafia Touil-Boukoffa, Junhua Wang, Eberhard Zeyhle, Tuerganaili Aji, Okan Akhan, Solange Bresson-Hadni, Chadli Dziri, Tilmann Gräter, Beate Grüner, Assia Haïf, Andreas Hillenbrand, Stéphane Koch, Michael T. Rogan, Francesca Tamarozzi, Tuerhongjiang Tuxun, Patrick Giraudoux, Paul Torgerson, Katherina Vizcaychipi, Ning Xiao, Nazmiye Altintas, Renyong Lin, Laurence Millon, Wenbao Zhang, Karima Achour, Haining Fan, Thomas Junghanss and Georges A. Mantion/Wikimedia
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Bile Duct Cancer
Bile duct cancer is rare. It can happen in the parts of the bile ducts that are outside or inside the liver. Risk factors include bile duct inflammation, ulcerative colitis, and certain liver diseases. Explore tests, diagnosis, treatment options, and survival rates associated with bile duct cancer.