Chemotherapy destroys cancer cells — but it can also damage healthy cells in the process. Because intravenous or oral medications are broken down by the liver, according to a September 2014 report in Clinical and Molecular Hepatology, liver damage can be a side effect of chemotherapy.
Your health care provider will routinely test your blood to detect any abnormalities in liver enzymes or other damage to the organ, especially if you have hepatitis or any other underlying liver condition. "We will do blood tests throughout your treatment to make sure this isn't happening," Kelsey Martin, MD, an oncologist and assistant professor of medicine at Yale School of Medicine, tells LIVESTRONG.com.
Your doctor will also determine the best course of action should liver problems be revealed. In the meantime, here are some of the possible effects of chemotherapy on the liver to know about.
Elevated Liver Enzymes
Enzymes speed up chemical reactions in the body. In the liver, they help remove toxins, produce bile and break down nutrients in food, according to the Cleveland Clinic. Higher-than-normal liver enzymes might be a sign of liver inflammation, a response to the extra work the organ does to metabolize chemo drugs while you're undergoing treatment.
However, liver enzymes can sometimes measure high on a blood test even if your liver is functioning just fine. "Since some medications can cause different patterns of abnormalities, we look very closely at a patient's bloodwork throughout treatment," Megan Kruse, MD, an oncologist at the Cleveland Clinic, tells LIVESTRONG.com.
High Bilirubin Levels
Another concern during chemotherapy is that the drugs can cause damage to liver cells that leads to a rise in bilirubin, a red blood cell byproduct found in bile, according to an August 2016 article published in JAMA Oncology. When your body can't excrete that excess bilirubin, your skin and the whites of your eyes may appear yellowish in color, called jaundice, according to the Mayo Clinic.
Depending on the extent of the jaundice and how you're responding to chemo, your doctor may test your bilirubin levels and tweak your treatment accordingly, Dr. Kruse says. "There is a threshold for how much abnormality should be taking place and, depending on how high the numbers go, we may take a short break, adjust medications or resume chemotherapy at a lower dose."
Chemotherapy may damage the liver itself and limit its ability to function properly. Such chemical- or drug-induced damage is known as hepatotoxicity, according to a June 2014 review article published in the Journal of Clinical and Translational Hepatology.
People with this condition may develop jaundice, fatigue and stomach pain, according to the U.S. Department of Health and Human Services. Some might need to discontinue medications that are processed through the liver. But this isn't always a lifelong condition. "Many times the liver can be affected during treatment but rebounds once treatment is complete," Dr. Kruse says.
Is This an Emergency?
- Journal of Clinical and Translational Hepatology: "Hepatotoxicity Secondary to Chemotherapy"
- Cleveland Clinic: "Elevated Liver Enzymes"
- Mayo Clinic: "Bilirubin Test"
- Clinical and Molecular Hepatology: "Chemotherapy Induced Liver Abnormalities: An Imaging Perspective"
- JAMA Oncology: "Jaundice (Hyperbilirubinemia) in Cancer"
- U.S. Department of Health and Human Services: "HIV and Hepatotoxicity"