Elevated liver enzymes are often detected during routine blood tests and usually indicate some form of liver stress or damage. While many causes exist, including infections, medications or liver diseases, certain cancers can also lead to raised liver enzyme levels. Understanding which cancers may cause this, how and why it happens can help guide diagnosis and treatment.

What Are Liver Enzymes?

Liver enzymes are proteins that help chemical reactions occur in the liver. Commonly measured liver enzymes in blood tests include alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT). Elevated levels of these enzymes usually indicate liver cell damage or bile flow problems.

How Can Cancer Affect Liver Enzymes?

Cancer can cause elevated liver enzymes in several ways. Tumours may directly involve the liver or spread (metastasise) to the liver from other parts of the body. Liver metastases disrupt normal liver function and cause damage to liver cells, leading to raised enzymes. Additionally, cancers near the bile ducts can obstruct bile flow, causing a buildup of enzymes in the blood.

Primary Liver Cancers

Primary liver cancers originate in the liver itself. The most common type is hepatocellular carcinoma (HCC), which arises from liver cells. HCC often develops in people with chronic liver diseases such as cirrhosis or hepatitis. As the tumour grows, it damages liver tissue causing elevated liver enzymes, particularly ALT and AST.

Cholangiocarcinoma is another primary liver cancer affecting the bile ducts. This type can cause raised alkaline phosphatase and GGT levels due to bile duct obstruction.

Secondary Liver Cancers (Metastases)

Many cancers that start elsewhere in the body can spread to the liver and cause elevated liver enzymes. Common cancers that metastasise to the liver include breast, colorectal, lung, pancreatic and stomach cancers. Liver metastases disrupt the liver’s normal structure and function, leading to increased enzyme levels.

Other Cancers Affecting Liver Enzymes

Certain blood cancers, such as lymphoma and leukaemia, can also affect the liver either by infiltration of cancer cells or through treatment effects, causing liver enzyme abnormalities. Additionally, cancers involving nearby organs like the pancreas or gallbladder may affect liver enzymes indirectly by causing bile duct obstruction or inflammation.

Symptoms and Diagnosis

Cancers causing elevated liver enzymes may not produce obvious symptoms early on. Some people might experience fatigue, jaundice (yellowing of skin or eyes), abdominal pain, weight loss or nausea. Elevated liver enzymes found on blood tests often prompt further investigations such as ultrasound, CT scans or MRI to assess liver structure and identify possible tumours.

A biopsy may be needed to confirm the diagnosis of cancer in the liver.

Treatment and Management

Treatment depends on the type, location and stage of the cancer. Options include surgery, chemotherapy, radiotherapy or targeted therapies. Managing liver enzyme abnormalities involves treating the underlying cancer and supporting liver function. Regular monitoring of liver enzymes helps assess treatment response and liver health.

When to Seek Medical Advice

If routine blood tests reveal elevated liver enzymes, it is important to consult a healthcare professional for further assessment. Persistent or unexplained enzyme elevations warrant investigation to rule out serious causes, including cancer.

Summary

Elevated liver enzymes can result from several cancers, especially primary liver cancers like hepatocellular carcinoma and cholangiocarcinoma, as well as cancers that have spread to the liver from other sites such as breast, lung or colorectal cancers. Blood cancers and nearby tumours may also cause enzyme changes. Early detection and diagnosis are essential for effective treatment and maintaining liver health.

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