The hepatologist is frequently asked to consult on the cancer patient taking chemotherapy when their LFT increases. Chemotoxicity, re-emergence of HBV and obstruction from metastatic disease should always be entertained.
In the case of breast cancer, a diagnosis of pseudocirrhosis should enter the equation when there is evidence of portal hypertension. In a recent case, a 43 year old female with known metastatic disease (to bone, marrow) presented with new onset jaundice. Physical exam showed palmar erythema, splenomegaly and ascites.
This patient had signs and symptoms of portal hypertension, and imaging of the liver revealed a nodular contour suggestive of cirrhosis (see image). A large metastatic tumor burden to the liver can mimic the radiographic findings of cirrhosis. A diagnostic test may include peritoneal biopsy, liver biopsy or ascitic fluid cytology. Of course, other causes of chronic liver disease should be ruled out.