Can Elevated Liver Enzymes be Cancer?

Yes, cancer can cause elevated liver enzymes, but there are other conditions and diseases where liver enzymes can be elevated. Additionally, elevated enzymes are not the only criteria to confirm the diagnosis of cancer. There are other factors and conditions to be ruled out first to confirm diagnosis of cancer.

There are two types of liver enzymes commonly found; serum aspartate aminotransferase (ALT or SGOT) and serum alanine aminotransferase (AST or SGPT). ALT is found mostly in the liver that helps in the metabolism of protein. ALT levels will normally be low in the body, but in case of damage its levels are increased in the blood stream; whereas, AST helps with the metabolism of alanine amino acid. AST level is usually found in high concentrations, but level higher than the normal also indicates liver damage or disease. Normal level of enzyme for ALT in adult male is 7 to 55 units per liter while for AST it is 8 to 48 units per liter. The normal levels may slightly differ for women and children.

Most common causes for elevation of liver enzymes are alcohol abuse, medications such as pain relievers, medications for seizures, antibiotics, and medications to lower cholesterol levels, antidepressant drugs, niacin, and cardiovascular drugs. An overweight or fatty liver may also cause liver enzymes to be elevated. The excess fat in the liver inflames the liver and ultimately leads to cirrhosis of liver. Other common causes include hepatitis A, hepatitis B, hepatitis C, and obesity. Liver enzymes can also be elevated in liver cancer, hypothyroidism, alcoholic hepatitis, CMV infection, heart diseases, pancreatitis, polymyositis, celiac disease, inflammation of gall bladder and liver cirrhosis.

The most common primary liver cancer is hepatocellular cancer, which is a cancer originating in the liver; however, all the blood passes through the liver, so cancer cells also pass along with the blood leading to many secondary cancers in the liver causing metastasis. It is important to rule out other conditions in order to confirm the diagnosis of liver cancer.

First step is to take a thorough history of the patient since most conditions may cause similar symptoms as liver cancer. Personal history is also very important that includes the history of smoking, infection with hepatitis B or C virus, consuming large amounts of alcohol, family history of liver cancer or other cancers. It is followed by a physical examination of the abdomen to look for any organomegaly or buildup of fluid, eye and skin for any yellowish discoloration and for swelling in the legs and feet (edema). Next important step is to get liver function tests done. They will not confirm the diagnosis of liver cancer, but indicate a problem in the liver.

Albumin is decreased in case of liver damage as the liver cells that produce this protein are damaged.

Bilirubin is increased when the liver is not working properly, it indicates excess breakdown of red blood cells. Excess bilirubin in the body will cause jaundice.

• Prothrombin time is decreased by liver damage or disease.
• Blood glucose level is decreased in liver disease.
• Alakaline phosphatase level is increased in liver damage.
• Alanine aminotransferase level is increased in liver disease.
• Aspartate aminotransferase level is also increased in liver disease.

In an ultrasound, if the liver is larger than normal it shows thickening growth or cyst in the liver. CT scan gives detailed images of the liver, its tissues and vessels. It gives information about the tumors size, shape and location and its spread to nearby tissues or organs. It also helps the doctor to decide if the tumor can be removed by surgery. MRI also shows detailed images of primary cancer and its spread. Biopsy confirms the diagnosis of liver cancer.

It is done based on the stage, liver function, and amount of scarring in the liver, whether or not it can be removed by surgery. Liver resection and liver transplant are the surgeries done.

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