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Obstructive Jaundice — SCE Medical Oncology MCQ

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ModerateOncological EmergenciesObstructive JaundiceSCE Medical Oncology

A 72-year-old woman with advanced lung cancer and liver metastases develops obstructive jaundice (bilirubin 180 µmol/L) from hilar lymphadenopathy compressing the common bile duct. She is planned for palliative chemotherapy. What intervention is required before chemotherapy can start?

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Correct answer: C — Biliary stenting (ERCP or percutaneous) to relieve obstruction and normalise bilirubin before chemotherapy

Obstructive jaundice impairs hepatic metabolism of most chemotherapy agents, increasing toxicity risk. Biliary decompression (endoscopic or percutaneous stenting) is required before chemotherapy can be safely administered. Most chemotherapy protocols require bilirubin ≤1.5× ULN before treatment. Metal self-expanding stents are preferred for malignant obstruction as they have longer patency than plastic stents. Improvement in bilirubin typically takes 1-2 weeks post-stenting.

Reference: NICE NG122 Lung cancer; ESMO 2024 Supportive Care Guidelines; BSG Guidelines on biliary stenting