Can Bilirubin, RBC Count, and Albumin Be Elevated in Liver Cancer?
Bilirubin can be elevated in liver cancer, but RBC count and albumin are typically decreased, not elevated. Understanding the directional changes of these laboratory values is critical for recognizing liver dysfunction in malignancy.
Bilirubin in Liver Cancer
Bilirubin elevation is common in patients with liver cancer, particularly when there is significant hepatic involvement or biliary obstruction. 1
- Elevated direct (conjugated) bilirubin often reflects liver dysfunction which may affect drug metabolism and elimination 1
- In patients with hepatocellular carcinoma (HCC) and liver metastases, bilirubin elevation indicates compromised hepatic function 1
- The combination of albumin and bilirubin (ALBI score) has been shown to stratify patients across disease stages and allows subgrouping of patients with different prognoses 1, 2
- Elevated bilirubin levels have been shown to predict risk of tumor recurrence after resection, risk of drop-out in patients on the waiting list for liver transplantation, and survival in advanced HCC 1
Clinical thresholds matter: Patients with baseline total bilirubin ≥2× upper limit of normal (ULN) should generally be excluded from clinical trials due to concerns of progressive hepatic failure 1
Albumin in Liver Cancer
Albumin is DECREASED, not elevated, in liver cancer patients with significant hepatic dysfunction. 1
- Albumin is produced only in the liver and serves as a marker of synthetic function 1
- As albumin is only produced by the liver, reduced serum albumin concentration indicates impaired hepatic synthetic capacity 1
- The ALBI grade (albumin-bilirubin) uses the combination of low albumin and elevated bilirubin to assess liver dysfunction in HCC patients 1, 2
- In patients with HCC, lower albumin levels correlate with worse prognosis and are incorporated into prognostic scoring systems 1, 2
Important caveat: Albumin concentrations are reduced in many clinical situations beyond liver disease, including sepsis, systemic inflammatory disorders, nephrotic syndrome, malabsorption, and gastrointestinal protein loss 1
Red Blood Cell (RBC) Count in Liver Cancer
RBC count is typically DECREASED, not elevated, in liver cancer patients. While the provided evidence doesn't directly address RBC elevation in liver cancer, the pathophysiology suggests reduction:
- Thrombocytopenia (low platelet count) is the most common hematological abnormality found in patients with chronic liver disease and is an indicator of advanced disease 1
- Multiple factors in chronic liver injury affect blood cell production: decreased production from bone marrow suppression (caused by alcohol, iron overload, drugs, and viruses), splenic sequestration from portal hypertension, and increased destruction 1
- Unconjugated hyperbilirubinemia can result from hemolysis (RBC breakdown), which would decrease rather than increase RBC count 1
Clinical Application: The ALBI Score
The albumin-bilirubin (ALBI) grade has emerged as a superior, objective measure of liver functional reserve in patients with HCC. 1, 2
- ALBI grade defines worsening liver impairment across 3 grades (I to III) using only albumin and bilirubin levels 1, 2
- It has been shown to correlate with survival, tumor relapse, and post-hepatectomy liver failure in patients treated with curative approaches 2
- ALBI grade can identify different subgroups of patients with different prognoses across diverse disease stages 1, 2
- The ALBI score gained superior prognostic value compared to Child-Pugh grade in patients with HCC who underwent liver resection 3
Summary Pattern in Liver Cancer
The typical laboratory pattern in liver cancer with hepatic dysfunction shows: