Can Elevated Liver Enzymes Be Cancer? Exploring the Link

It is a natural reaction to worry if you get abnormal results in your blood work. But can elevated liver enzymes be cancer? When you get this kind of result, do you need to get worried? Cancer can increase your liver enzymes. But so do other harmless conditions. Understanding your test results can help you make informed decisions. Some cancers like colorectal cancer have a 70% risk of developing liver metastasis, which could be the culprit of the increase in your liver enzymes.

Key Points

• Increased liver enzymes doesn’t always mean cancer — fatty liver disease alone can cause increased liver enzymes in 25-51% of cases

• 70% of patients with colorectal cancer has liver metastasis contributing to increased liver enzymes

• There are five main enzymes that doctors check for liver health (ALT, AST, ALP, GGT, LDH)

• About 30% of people with high liver enzymes return to normal in 2-4 weeks

• Early liver disease, cancer in particular, will not show symptoms. Hence, the importance of regular testing

• AFP marker levels also increase as liver cancer advances

What Are Liver Enzymes?

Liver enzymes are proteins that help the liver in its daily work. They are essential for metabolism (which is an activity that allows breakdown not only of food but other substances). The liver also utilizes these enzymes to clear out toxins and wastes from the body. Moreover, the liver also produces substances that the body needs.

Doctors order blood tests that measure these enzymes to ensure liver function and health. These enzymes include the following, which reflect different problems:

Each enzyme demonstrates different problems. When liver cells get damaged, these enzymes leak into your blood. Making them detectable during blood work.

Can Elevated Liver Enzymes Be Cancer?

High liver enzymes on blood tests can be cancer, but is not proof enough. There are other conditions that can increase these enzymes, as well. So high results don’t automatically mean you have cancer.

Breast, colorectal, liver, and pancreatic cancers can all cause long-term increase in liver enzymes. Cancer, whether primary or metastatic (spread), can damage liver cells. The damaged liver cells will then release the enzymes within them.

The distinguishing feature  between cancer and non-cancer elevation of liver enzymes is “long-term” or persistent. Cancer often makes these enzymes persistently high or gradually increasing over time. But for non-cancer causes, it only causes temporary increase then goes away.

In order to prove that the cause is really cancer, doctors need other confirmatory tests. It does not only involve liver enzyme tests but a plethora of other laboratory and diagnostic tests including:

• Blood tests

• Imaging

• Biopsies

Most people don’t have cancer when their liver enzymes return high. A lot of treatable conditions cause these elevations. So early diagnosis is important, which leads to better outcomes.

Which Cancers Are Linked to Elevated Liver Enzymes?

A number of cancers can cause elevated liver enzymes. It includes the following:

• Primary liver cancer. The cancer that starts in the liver. The most common of which is hepatocellular carcinoma (HCC).

• Colorectal cancer commonly spreads (metastasize) to the liver because the intestinal blood flows directly there. Up to about 70% of advanced colorectal cancer cases will demonstrate liver spread.

• Pancreatic cancer can affect the liver in two different ways. Over 50% of cases spread to the liver, directly causing damage to the cells. However, even when it does not spread to the liver, the tumor can block the bile ducts due to size, making it difficult for bile to pass through, resulting in higher enzyme levels.

• Bile duct cancer can block bile flow, causing specific increase in enzyme patterns. This cancer often raises ALP and GGT more than ALT or AST.

• Other cancers that may spread to the liver:

• Breast

• Lung

• Skin

What Is the Difference Between Primary and Metastatic Liver Cancer?

Understanding the difference between primary and metastatic liver cancer is key to explaining why liver enzymes increase and what treatments will work.

Primary liver cancer starts within the confines of the liver itself. It does not come from elsewhere or from any organ in the body. HCC, as previously mentioned, is the most common. It causes direct damage to healthy liver cells.

Metastatic (also called secondary)  liver cancer, on the other hand, comes from cancer occurring elsewhere in the body. Colorectal cancer most commonly affects the liver, where cancer cells travel through blood.

Both of these liver cancers can increase liver enzyme patterns but of slightly different patterns.

• Primary liver cancer increases ALT and AST because it directly affects the healthy liver cells

• Metastatic liver cancer may demonstrate mixed liver enzyme patterns depending on how much tissue has been replaced by cancer cells

Treatment for each of these types vary considerably primarily because of the target organ for management.

What Else Causes Elevated Liver Enzymes?

Many harmless conditions cause high levels of liver enzymes. These conditions are more common than cancer-related conditions.

• Fatty liver disease accounts for about 25-51% of high liver enzyme cases.

• Viral hepatitis particularly B and C

• Medications like acetaminophen, cholesterol drugs, and many others can stress the liver. However, about 30% of people with high enzymes would return to normal in 2-4 weeks after stopping the medication.

• Alcohol consumption frequently increases liver enzymes. Heavy drinking, in particular, can damage liver cells.

• Autoimmune conditions like autoimmune hepatitis result in inflammation of the liver cells, which is due to the immune system attack.

• Genetic conditions like Wilson’s disease, hemochromatosis, and alpha-1 antitrypsin deficiency.

However, when these conditions reach a point where cirrhosis sets in, it increases the risk for HCC. In fact, about 80-90% of patients with HCC have cirrhosis.

Are Elevated Liver Enzymes Temporary or Persistent?

The specific timeline of elevated liver enzymes will prompt the nature of its cause. Transient (temporary) increases often have different causes. Often, it includes:

• Medications

• Sudden illness

• Exercise

• Food poisoning

• Severe dehydration

However, chronic (long-term) elevations often indicate chronic conditions. These may include fatty liver disease, hepatitis, or even cancer.

The pattern of elevation also matters. Progressively and persistently high liver enzymes are much more concerning than stable, mildly high levels. Cancerous increase in liver enzymes often reflects a progressive pattern.

What Are the Symptoms to Watch For?

Many people who have high liver enzyme results often display no symptoms. However, symptoms, when they do appear, are clues to what is causing it exactly. Symptoms could include:

• Extreme fatigue or easy fatigability

• Jaundice (yellowish discoloration of the whites of eyes and skin)

• Abdominal pain

• Changes in urine and stool color

• Nausea

• Vomiting

• Loss of appetite

When your liver is affected, anything that’s related to protein production, breakdown of food, and elimination of toxins will become evident as symptoms.

What are the Symptoms of Liver Cancer and Other Related Cancers?

Cancer symptoms, whether liver or other related cancers, often develop gradually and slowly. They might not even appear until the cancer has advanced. This is where the importance of regular screening comes in. The symptoms could include:

• Abdominal pain

• Unintentional or unexplained weight loss

• Abdominal swelling (gradual increase in abdominal girth)

• Feeling full quickly when eating

• Bowel changes

• Blood in stool

• Persistent back pain

• Breathing problems (particularly for lung cancer)

• Persistent cough

• Chest pain

The challenge for many symptoms in liver metastasis is that it can overlap with other conditions, which make them vague. This is the reason why testing or screening is often recommended when you possess the risk.

How Are Elevated Liver Enzymes Diagnosed?

Diagnosing elevated liver enzymes requires a systematic approach. Often it starts with simple tests and moves on to complex ones based on the initial findings.

Systematic approach includes the following steps:

• Complete medical history

• Physical examination

• Initial blood works include liver function test and with the addition of other tests depending on presentation and suspicion like hepatitis panel, autoimmune markers, and iron levels

• Based on a high index of suspicion, cancer tests may be included such as alpha feto protein (AFP) and carcinoembryonic antigen (CEA)

It is important to abstain from alcohol throughout this process to avoid confounding the results.

Deep Dive on Blood Tests and Biomarkers

Blood tests that were mentioned earlier offer important information regarding liver function. It can help identify the cause of enzyme elevation, as well.

Apart from the five different liver enzymes, some additional tests often assess liver function, including:

• Bilirubin levels

• Albumin levels

• Prothrombin time

Biomarkers for cancer activity or presence include:

• Alpha-feto protein (usually high in advanced liver cancer). Normal AFP range can be anywhere from 0-10 ng/mL but this could be extremely high in liver cancer.

• Carcinoembryonic antigen is non-specific but could rise in several types of cancer, like colorectal cancer. However, this biomarker could be used for monitoring of treatment response or even detect cancer return.

• Hepatitis panels such as tests for the presence of Hepatitis B and C viruses are important to rule out chronic liver inflammation. These infections increase your risk for cancer.

• Specialized tests like ceruloplasmin for Wilson’s disease, iron studies for hemochromatosis, or antinuclear antibodies for autoimmune disease are all done depending on the index of suspicion

Are Imaging Tests Useful?

When blood tests suggest a serious underlying condition, imaging tests and sometimes biopsies could offer a more definitive diagnosis. Some of the imaging tests done, include:

• Ultrasound

• Computed tomography (CT) scan

• MRI

Biopsies are often done for confirmatory, especially if the tests and imaging remained inconclusive. It can determine what stage the cancer is and assess the degree of liver damage.

However, what imaging to use depends on how your doctor evaluated you. Your doctor will recommend tests appropriate for the symptoms, blood test results, and clinical findings that you have.

What to Do if You Have Elevated Liver Enzymes?

Finding elevated liver enzymes in your test results can be quite scary. But taking the right steps and being proactive can help your doctor find the cause and the right treatment if necessary.

Some of the things you can do, include the following:

• Avoid things that will damage your liver further, such as alcohol

• Disclose and review all the medications you are taking with your doctor

• Follow-up with repeat blood tests if requested

• Make lifestyle changes, such as maintaining a healthy diet and exercise

• Maintain a healthy weight

• Stop smoking

• Manage underlying conditions like hypertension (high blood pressure) or diabetes

• Keep track of all the symptoms you have and document any new onset symptom for reporting to your doctor

 

 

When Should You Seek Medical Attention?

Knowing exactly when to seek medical attention is helpful in ensuring you improve your outcomes.

Report to your doctor if you experience any of the following:

• Jaundice

• Severe abdominal pain

• Persistent nausea or vomiting

Chronic elevations of liver enzymes would require additional testing for confirmation. 

You should consider seeing a hepatologist (liver specialist) if your primary doctor still can’t find the exact cause why you have elevated liver enzymes. More often, you will be referred immediately so your diagnosis will not get delayed. Hepatologists often have training on advanced diagnostic procedures.

If you have cancer risk, such as hepatitis B and C infection or a family history, take your liver enzyme elevation seriously.

At all costs, do not delay seeking medical attention for any serious or new onset symptoms you have. Early diagnosis and intervention always improve outcomes.

Conclusion

Elevated liver enzymes can signal various conditions, including cancer, but are not definitive proof of malignancy. While cancers like colorectal, liver, or pancreatic can cause persistent enzyme elevations, common causes like fatty liver disease (25-51% of cases) or medications are more likely. Regular testing is important, as early liver cancer often lacks symptoms. Diagnostic steps, including blood tests, imaging, and biopsies, help pinpoint the cause. Proactive measures like avoiding alcohol, maintaining a healthy lifestyle, and monitoring symptoms are essential. If enzymes remain elevated or symptoms like jaundice appear, consulting a hepatologist promptly ensures timely diagnosis and better outcomes.

Ready to start with tracking your liver health? Check Ribbon Checkup testing strips, you can now track your health without leaving the comforts of your home.

For more resources, read these articles:

What is an Echogenic Liver? Understanding Ultrasound Findings

What Are the Signs That Pancreatic Cancer Has Spread to Liver?

Frequently Asked Questions

Can elevated liver enzymes always mean I have cancer?

No, elevated liver enzymes don't always mean you have cancer. Majority of the cases are caused by benign conditions such as fatty liver disease.

Which cancers most commonly cause elevated liver enzymes?

Primary liver cancer and colorectal cancer that has spread to the liver are two of the most common cancers that may cause elevated liver enzymes.

How high do liver enzymes get with cancer?

Cancer-related enzyme elevations vary widely. It depends on the degree of damage and how advanced the cancer is. The pattern and persistence of elevation matter more than the absolute numbers.

Written by Jaclyn P. Leyson-Azuela, RMT, MD, MPH
Jaclyn P. Leyson-Azuela, RMT, MD, MPH, is a licensed General Practitioner and Public Health Expert. She currently serves as a physician in private practice, combining clinical care with her passion for preventive health and community wellness.

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