Which of the following statements about jaundice is false: jaundice does not occur as a consequence of cancer, jaundice can occur as the result of decreased conjugation of bilirubin by the liver, disorders of the liver, bile duct, or pancreas may cause jaundice, or jaundice may occur due to hemolysis?

The FALSE Statement About Jaundice

The statement "Jaundice does not occur as a consequence of cancer" is FALSE. Cancer is a well-established and significant cause of jaundice, accounting for a substantial proportion of cases in clinical practice.

Why This Statement is Incorrect

Malignancy is documented as one of the most common causes of jaundice, particularly severe jaundice. 1

• European studies identify malignancy as the most common etiology of severe jaundice 1
• In U.S. studies, malignancy accounts for 6.2% of all jaundice cases 1
• In primary care cohorts, 27% of jaundiced patients had an explanatory cancer, including pancreatic cancer (12%), cholangiocarcinoma (5%), and other primary malignancies (10%) 2

Mechanisms of Cancer-Related Jaundice

Cancer causes jaundice through multiple pathways 1:

• Biliary obstruction from tumors compressing or invading the common bile duct (most common mechanism)
• Hepatocellular carcinoma with bile duct thrombosis, occurring in 1.2-9% of HCC cases 3
• Tumor invasion directly into the biliary tree 3
• Metastatic disease causing intrahepatic obstruction

Why the Other Statements Are TRUE

Decreased Conjugation Causes Jaundice

Impaired bilirubin conjugation is a recognized pathophysiological mechanism causing unconjugated hyperbilirubinemia 1, 4, 5:

• Gilbert syndrome represents the classic example of impaired conjugation 6
• The American College of Radiology lists "impaired bilirubin conjugation" as one of four main categories of jaundice pathophysiology 4

Liver, Bile Duct, and Pancreatic Disorders Cause Jaundice

These organs are central to bilirubin metabolism and bile flow 1, 4:

• Liver disorders: Hepatitis, alcoholic liver disease (16%), cirrhosis decompensation (20.5%) 1
• Bile duct disorders: Choledocholithiasis (14%), cholangiocarcinoma 1, 2
• Pancreatic disorders: Pancreatitis and pancreatic malignancy causing biliary obstruction 1

Hemolysis Causes Jaundice

Hemolysis produces unconjugated hyperbilirubinemia through bilirubin overproduction 4, 5, 6:

• Accounts for 2.5% of jaundice cases in U.S. studies 1
• Represents a prehepatic cause with elevated indirect bilirubin 5, 6
• The American College of Radiology explicitly lists "bilirubin overproduction" from hemolysis as a pathophysiological category 4