What Cancers Cause Elevated Liver Enzymes?
Liver enzymes are proteins produced by your liver. They are essential for various body processes, such as digestion and cellular metabolism.
Testing of liver enzymes is commonplace. Your doctor might order liver enzyme blood tests for a range of different symptoms or even for routine monitoring.
Many medical conditions can inflame or damage liver cells, causing them to release elevated levels of liver enzymes. Liver enzyme elevation may be temporary following an illness or a side effect of medication or supplements.
In some people, liver enzyme tests normalize, and the cause remains unknown. But in rare cases, persistently elevated liver enzymes can be caused by certain types of cancer.
Read on to learn what types of cancer typically cause elevated liver enzymes.
Liver cancer
Hepatocellular carcinoma (HCC) causes more than 90% of primary liver cancer. Primary means the cancerous tumors originate in your liver instead of spreading there from elsewhere. HCC is the fifth most common cancer worldwide.
HCC is strongly associated with:
- chronic viral hepatitis
- alcohol-related liver disease
- nonalcoholic fatty liver disease (NAFLD)
- cirrhosis
Symptoms of liver cancer
Common symptoms of liver cancer include:
- abdominal pain
- lump in the right upper abdomen
- jaundice
Read more about the symptoms of liver cancer.
How doctors diagnose liver cancer
Liver cancer is usually diagnosed with a combination of screening blood tests and medical imaging, such as an ultrasound, CT scan, or MRI.
Your doctor can help you understand the risks and benefits of a liver biopsy.
Liver-related blood tests, including bilirubin, albumin, liver enzymes, and a measurement of your blood clotting function called your prothrombin time (PT/INR), can all be abnormally elevated in liver cancer.
Another blood test called alpha fetoprotein (AFP) may also be high in advanced HCC. This is due to liver inflammation, damage, and bile duct blockage caused by the cancer.
Colorectal cancer
Colorectal cancer is the most common cause of secondary or metastatic liver tumors. This is when a cancer that originally started elsewhere in the body travels to the liver.
Up to 70% of people with colorectal cancer will eventually develop liver metastases because the blood supply from the intestine is connected directly to the liver. One potential sign of liver metastases is elevated liver enzyme tests.
Symptoms of colorectal cancer
Common early symptoms of colon cancer include:
- stool changes, including changes to:
- frequency
- color
- appearance
- abdominal pain
Read more about the symptoms of colon cancer.
How doctors diagnose colorectal cancer
Doctors most often diagnose colon cancer using diagnostic colonoscopy and biopsy. Staging, including checking for liver metastases, is performed with CT scans.
Surgery and chemotherapy may still be effective treatment options when colon cancer has spread to the liver.
Breast cancer
Breast cancer accounts for nearly one-third of all cancers in women, and the liver is one of the most common sites of breast cancer metastasis.
Symptoms of breast cancer
There are many different types of breast cancer. Early signs and symptoms may include:
- a new lump in the breast
- breast skin changes
- altered nipple appearance or discharge
Read more about the symptoms of breast cancer.
How doctors diagnose breast cancer
Doctors diagnose breast cancer using medical imaging, such as mammograms, ultrasounds, and MRIs. They will perform a biopsy if they identify an area of concern on imaging.
As part of your initial evaluation, doctors will stage your cancer. This may include liver enzyme testing and imaging to check for breast cancer liver metastases.
The presence of liver metastases in breast cancer is associated with lowered 5-year survival.
A 2023 study suggests that monitoring liver enzyme blood tests in people with breast cancer may be a helpful early marker of liver involvement. This is important because early surgical treatment of breast cancer liver metastases can prolong life expectancy.
Lung cancer
Lung cancer is the second most common cancer in the United States. It is another common cause of metastatic liver tumors causing elevated liver enzymes.
Lung cancer is highly associated with cigarette smoke exposure and other inhaled carcinogens. However, not all cases of lung cancer occur in smokers.
Symptoms of lung cancer
The most common symptoms of lung cancer are:
- persistent cough
- chest pain
- shortness of breath
Read more about the symptoms of lung cancer.
How doctors diagnose lung cancer
The diagnosis and staging of lung cancer, including evaluation for the presence of liver and other metastases, is accomplished with CT and PET scanning.
Stomach and esophageal cancers
Gastric cancer rates are declining worldwide, and esophageal cancer is relatively rare in the United States. However, both cancers are frequently diagnosed at an advanced stage, and both tend to metastasize to the liver, producing elevated liver enzymes.
Symptoms of esophageal cancer
The most common symptoms of esophageal cancer are:
- difficulty or pain with swallowing
- weight loss
- abdominal pain
- decreased appetite
Read more about the symptoms of esophageal and gastric cancers.
How doctors diagnose stomach and esophageal cancers
When doctors suspect gastroesophageal cancer, diagnostic evaluation may include laboratory testing, imaging, and upper endoscopy procedures with biopsies.
Pancreatic cancer
Pancreatic cancer accounts for about 3% of annual cancer diagnoses in the United States.
More than half of pancreatic cancers have spread to the liver by the time of diagnosis. This often blocks the bile ducts, producing some hallmark pancreatic cancer symptoms like jaundice and elevated liver enzymes.
Symptoms of pancreatic cancer
In its early stages, there may be few or vague symptoms. The most common later symptoms of pancreatic cancer include:
- painless jaundice
- unintended weight loss
- abdominal or back pain
Read more about the symptoms of pancreatic cancer.
How doctors diagnose pancreatic cancer
When doctors suspect pancreatic cancer based on your symptoms and blood test results, they’ll order imaging such as CT, PET, or MRI/MRCP scans to confirm your diagnosis and help stage your disease.
Skin cancer (melanoma)
Diagnoses of melanoma skin cancer have risen rapidly over the past 50 years. Melanoma is an aggressive cancer that can metastasize to multiple sites, including the liver.
Melanoma is strongly associated with ultraviolet light exposure, and it usually appears on sun-exposed areas of the skin.
Symptoms of melanoma
The primary symptoms of melanoma are:
- an existing mole that is changing
- a new and growing mole
- a skin lesion or mole that is itchy or bleeding
Read more about monitoring skin lesions for the ABCDE characteristics of melanoma.
How doctors diagnose skin melanomas
If you have concerns about a mole or skin lesion, see a doctor right away. Your mole may be examined or removed by punch or excisional biopsy to determine a diagnosis.
Noncancerous causes of elevated liver enzymes
Elevated liver enzymes found incidentally on routine blood testing may resolve themselves in a matter of weeks, and there may not be a serious cause.
If your liver tests remain abnormal, or you have other concerning symptoms, your doctor will work with you to determine the reason. Noncancerous potential causes of elevated liver enzymes include:
- alcohol use
- fatty liver disease (alcoholic or NAFLD)
- metabolic syndrome
- medications (such as statins or acetaminophen)
- supplements and herbs (such as iron or vitamin A)
- hepatitis (infectious and autoimmune)
- hemochromatosis
- cirrhosis
- celiac disease
- hepatobiliary diseases (primary sclerosis cholangitis, primary biliary cirrhosis)
- Wilson’s disease
- alpha-1 antitrypsin deficiency
- muscle disease
- thyroid disease
- hemolysis
What are liver enzymes?
Your liver performs several vital processes in your body, including filtering toxins, processing and digesting nutrients, and regulating energy metabolism. It also synthesizes substances needed for digestion, immune function, and blood clotting.
Although your liver produces many enzymes and chemicals, liver enzyme tests generally include:
- ALT (alanine aminotransferase)
- AST (aspartate aminotransferase, also found in heart, muscle, and brain tissue)
- GGT (gamma-glutamyltransferase, present in a variety of other tissues)
- ALP (alkaline phosphatase, also commonly found in bone, intestine, and placental tissues)
Liver enzymes are often checked as part of a larger panel of liver function blood tests, which also include bilirubin, albumin, and PT/INR.
Symptoms of abnormal liver function
- abdominal pain
- jaundice (an abnormal yellow color of your skin or eyes)
- dark brown urine
- whitish or clay-colored stools
- itching
- fatigue
- loss of appetite
- nausea or vomiting
- unusual bleeding or blood clots
Frequently Asked Questions about Elevated Liver Enzymes and Cancer
What are liver enzymes?
Liver enzymes are proteins produced by the liver that help speed up chemical reactions in the body. The most common enzymes measured in blood tests include alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), and gamma-glutamyl transferase (GGT).
What does it mean when liver enzymes are elevated?
Elevated liver enzymes suggest that the liver is inflamed or damaged, releasing more enzymes into the bloodstream than normal. This can be a sign of various conditions, including liver diseases, metabolic disorders, or issues like cancer.
Can cancer cause elevated liver enzymes?
Yes, certain cancers can lead to elevated liver enzymes. This typically occurs when cancer affects the liver directly, either because it originates there or spreads to the liver from another part of the body (metastasis).
What types of cancer are associated with elevated liver enzymes?
Cancers that may cause elevated liver enzymes include:
- Liver Cancer (Hepatocellular carcinoma): This cancer starts in the liver and can directly increase liver enzyme levels.
- Metastatic Cancer: Cancers from other organs, such as the colon, pancreas, stomach, or breast, can spread to the liver, causing enzyme elevations.
- Bile Duct Cancer (Cholangiocarcinoma): A cancer originating in the bile ducts can lead to liver damage and elevated enzymes.
How are elevated liver enzymes detected?
Elevated liver enzymes are typically detected through a routine blood test called a liver function test (LFT). The test measures the levels of various liver enzymes in the blood.
What should I do if my liver enzymes are elevated?
If your liver enzymes are elevated, it’s essential to follow up with your healthcare provider. They may recommend further tests to determine the underlying cause and decide on appropriate treatment options.
Can non-cancerous conditions cause elevated liver enzymes?
Yes, many non-cancerous conditions can also lead to elevated liver enzymes, including:
- Viral hepatitis
- Fatty liver disease
- Alcoholic liver disease
- Medication side effects
- Gallbladder disease
Is it possible to lower elevated liver enzymes?
Managing the underlying cause can often help lower elevated liver enzymes. Treatment may include lifestyle changes, medication adjustments, or specific therapies depending on the diagnosis. Always consult a healthcare professional for guidance.
Ensuring awareness and understanding of potential health issues, like those linked to elevated liver enzymes and cancer, allows for timely medical evaluations and interventions.
Takeaway
Your liver enzymes are vital to many digestive, metabolic, and other cellular functions in your body.
When liver cells are injured, inflamed, or otherwise affected by disease, doctors may notice abnormally high liver enzymes on your blood tests.
There are many potential causes of elevated liver enzymes. In the United States, alcoholic liver disease and nonalcoholic fatty liver disease are the most common causes. But occasionally, cancer is the cause of persistently elevated liver enzymes.
Primary liver cancer, which begins in the liver, can cause abnormal liver enzymes. Colorectal cancer is the most common secondary or metastatic cause of liver tumors.
Many other cancers can also metastasize to the liver and cause elevated liver enzymes, among other symptoms. These include breast, esophageal, stomach, pancreatic, lung, kidney, and melanoma skin cancers.
Talk with a doctor if you notice symptoms of elevated liver enzymes or have cancer-related concerns.
