# Obstructive jaundice and biliary obstruction

Source: https://onco.cc/terms/obstructive-jaundice/  
OnCo record `obstructive-jaundice` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Yellowing of the skin and eyes because a tumour blocks the bile duct, most often pancreatic or bile duct cancer. It causes itching, infection risk and dark urine, and it must be relieved (usually with a stent) before chemotherapy can be given safely.

## Summary

Most pancreatic head, distal bile duct and ampullary cancers present with painless jaundice; perihilar cholangiocarcinoma obstructs higher up. Bilirubin above about 1.5× normal precludes most chemotherapy (irinotecan, taxanes and many TKIs are cleared by the liver), so ERCP-placed metal stents or percutaneous drainage come first, with antibiotics for cholangitis. Other malignant obstructions treated by stenting, surgery or radiotherapy include gastric outlet, bowel (managed medically with octreotide and steroids in advanced disease, or surgically), airway, superior vena cava (SVC syndrome) and ureteric obstruction causing hydronephrosis, which impairs cisplatin eligibility in bladder and cervical cancer.

## Fields

- Kind: Term
- Last checked: 2026-09-09
- Also known as: jaundice; obstructive jaundice; biliary obstruction; bile duct obstruction; cholestasis; cholangitis; bilirubin; elevated bilirubin; hyperbilirubinaemia; hyperbilirubinemia; biliary drainage; pruritus from cholestasis; malignant bowel obstruction; bowel obstruction; intestinal obstruction; gastric outlet obstruction; airway obstruction; SVC syndrome; superior vena cava syndrome; ureteric obstruction; hydronephrosis

## Notes

- Pancreatic cancer in the head of the gland blocks the bile duct early, so jaundice is often the first sign. Pancreatic Cancer UK says surgery treats the jaundice if it is happening straight away, a stent is used if you are not yet fit or will have chemotherapy first, and it may take two to three weeks for the yellowing, itch and tiredness to clear. NICE NG85 says offer a pancreatic protocol CT before draining the bile duct.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Jaundice
- Wikipedia: https://en.wikipedia.org/wiki/Jaundice
- Pancreatic Cancer UK: treating jaundice if you have pancreatic cancer: https://www.pancreaticcancer.org.uk/information-and-support/managing-symptoms-and-side-effects/managing-jaundice-if-you-have-pancreatic-cancer/
- NHS: jaundice: https://www.nhs.uk/conditions/jaundice/
- NICE NG85: pancreatic cancer in adults, diagnosis and management, recommendations: https://www.nice.org.uk/guidance/ng85/chapter/Recommendations

## Connected records

- terms: [Biliary drainage routes: ERCP stent, percutaneous (PTC) and EUS-guided](https://onco.cc/terms/biliary-drainage-routes/), [Biliary stent problems: blockage and infection](https://onco.cc/terms/biliary-stent-problems/), [Cholangitis: infection of a blocked bile duct](https://onco.cc/terms/acute-cholangitis/), [Emergency presentation (route to diagnosis)](https://onco.cc/terms/emergency-presentation/), [Endoscopy (EGD, EUS, ERCP)](https://onco.cc/terms/endoscopy/), [Hepatotoxicity (liver enzyme elevation)](https://onco.cc/terms/hepatotoxicity/), [High-risk stigmata and worrisome features of pancreatic cysts (IPMN and MCN surgical criteria)](https://onco.cc/terms/pancreatic-cyst-high-risk-stigmata/), [Living with jaundice and itching (biliary cancer)](https://onco.cc/terms/jaundice-and-itch-biliary/), [Palliation in pancreatic cancer: biliary and duodenal stents, coeliac plexus block, enzymes and cachexia](https://onco.cc/terms/pancreatic-palliation-obstruction-pain-nutrition/), [Pancreas protocol CT (pancreatic protocol CT, dual-phase thin-slice CT with structured reporting)](https://onco.cc/terms/pancreas-protocol-ct/), [Pancreatic enzyme replacement therapy (PERT, pancreatin, Creon) for pancreatic exocrine insufficiency: why and how to take it](https://onco.cc/terms/pancreatic-enzyme-replacement/), [Stent or bypass for jaundice: the choice](https://onco.cc/terms/stent-or-bypass-for-jaundice/), [Stenting (biliary, oesophageal, airway)](https://onco.cc/terms/biliary-stent/), [Symptom control in advanced gallbladder cancer: pain, ascites and nutrition](https://onco.cc/terms/gallbladder-cancer-symptom-control/), [When to seek urgent help with gallbladder cancer (NHS 111 and 999)](https://onco.cc/terms/urgent-help-gallbladder-cancer/), [Whipple procedure (pancreaticoduodenectomy)](https://onco.cc/terms/whipple/)
- cancers: [Ampullary cancer (ampulla of Vater)](https://onco.cc/cancers/ampullary/), [Biliary tract cancer (cholangiocarcinoma)](https://onco.cc/cancers/cholangiocarcinoma/), [Cystic duct carcinoma](https://onco.cc/cancers/cystic-duct-carcinoma/), [Gallbladder cancer](https://onco.cc/cancers/gallbladder/), [Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors](https://onco.cc/cancers/ipmn-cystic-precursors/), [Locally advanced unresectable pancreatic ductal adenocarcinoma](https://onco.cc/cancers/locally-advanced-pdac/), [Metastatic pancreatic ductal adenocarcinoma](https://onco.cc/cancers/metastatic-pdac/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/), [Resectable pancreatic ductal adenocarcinoma](https://onco.cc/cancers/resectable-pdac/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- roadmaps: [Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question](https://onco.cc/roadmaps/pancreatic-roadmap/)
- ideas: [A fast-track pathway from suspicion to treatment for pancreatic cancer in the NHS, measured from first scan to first treatment](https://onco.cc/ideas/idea-pdac-uk-fast-track-diagnosis-to-treatment-pathway/)
- trials: [TESLA RCT](https://onco.cc/trials/tesla-rct/)

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