Dr. Balaraman Nair, Retd. Director of Medical Education, Thiruvananthapuram
The term neoplasm is not synonymous to cancer. But it refers to a new growth anywhere in the body which may be benign (harmless) or cancerous (harmful). Everyone has a benign neoplasm in their body. But benign tumours of large size in certain parts of the body such as brain, eye or in hepatic biliary system will be harmful. Therefore, Jaundice in relation to neoplasm is not always associated with cancer but also with benign ones.
According to allopathy, Jaundice is the yellowish colouration of the skin, conjunctiva of eye and other tissues of the body. It is sometimes associated with the excretion of bile in the urine called biliuria. Jaundice is not a disease, it is only a symptom which shows some disturbances in the synthesis, manufacture, secretion and excretion of the bile. So the present discussion is only about one of the symptoms, the Jaundice, related to neoplasm.
The general concept or misunderstanding is that the bile is formed in the liver. But it is only partially true. The bile is formed in the entire human body. It is from the Haemoglobin of RBC in a system called Reticulo Endothelial System where the worn-out or deceased RBCs are destroyed, the bile is formed. Yet we do not suffer from Jaundice. This is because of the immense reserve power of the liver. Even if a substantial part of liver is removed, still the remaining part of the liver is capable of removing the raw materials from the body, otherwise it will give rise to disease.
The bile formed in this way is different from the bile that reaches the intestine through the bile duct. All the bile formed in the different parts of the body is transported to the liver by blood. This bile is bound to protein that is insoluble in water. Hence they do not appear in the urine. This bile is called unconjugated bile. Only if it is soluble in water it is excreted through the urine. The bile that brought to the liver undergoes a series of reaction and is converted to a conjugated form which is water soluble.
The bile that is brought to the liver is taken into the hepatic cells where it undergoes a transition and the conjugated bile is secreted continuously by these cells into the minute bile canaliculi that lie lies in between these hepatic cells. The bile canaliculi empty the bile into the terminal bile ducts, finally reaching the hepatic ducts. The hepatic ducts of right and left lobes join together into a common duct and the bile is stored in the gall bladder. The gall bladder secretes bile into the common bile duct through cystic duct which opens into duodenum along with the pancreatic duct.
Jaundice is only a symptom of many diseases. This means that it can occur due to a number of diseases. They are:
1. When the raw materials are produced in large amounts:
Suppose that there is an excess destruction of RBC, large amount of insoluble bile is brought to the liver. As a result, it gets accumulated and the hepatic cells simply cannot excrete the excess bilirubin as rapidly as it is formed. Here, the liver cannot metabolise all the unconjugated bile formed into a soluble conjugated bile. Thus it is not a disease associated with hepato-biliary system, instead, accumulation of excess of unconjugated bile leads to Jaundice. So in this type of Jaundice, no bile is excreted in the urine (Acholuric), because the bile is insoluble in water. The excess bile remains in the blood to cause severe Jaundice. This type of Jaundice is called "Prehepatic Jaundice" or "Haemolytic Jaundice".
In this case when a large number of liver cells are damaged as a result of a disease, for example viral, even the normal amount of bile brought to the liver are not properly metabolised and cannot move out into the biliary duct. This type is called "Hepatic Jaundice".
This defect may be a block due to a neoplasm or by the formation of stones (concretions) in the passages through which the bile flow. Hence the materials cannot be transported from the site of formation to the site of storage and excretion. This is called Post-Hepatic Jaundice or Obstructive Jaundice. This is very much related to neoplasms. Owe to the block on the way, the water soluble bile in regurgitated back into the blood and is excreted through the urine causing Jaundice.Download complete Research Papers