Mysterious jaundice is actually related to smoking

This is the 3806th article of Da Yi Xiao Hu

Lao Wang is a COPD patient. He has been receiving follow-up treatment from me for five years. Although his condition is gradually getting worse, it is generally under control. He can ride a bicycle and do other activities. However, Lao Wang can still not quit smoking. When he sees me, he often says: "Doctor Liu, it's a good thing that you pointed out this asthma for me. I am much better now and can still smoke." This makes me laugh and cry.

But this time, Lao Wang came to see me not because of asthma. In the past month, because of the epidemic, Lao Wang stayed at home every day and smoked more than usual. His wife found that his complexion was getting uglier and uglier, so this time she came to my clinic for consultation. When I walked into my clinic, I saw that Lao Wang's face was actually a manifestation of jaundice. I took a special look at his conjunctiva, and there was obvious yellowing. It is true that smoking can cause the skin to become gray and darker, but it will not cause jaundice. I asked Lao Wang to do a blood biochemical test quickly. The results of the test did show a significant increase in bilirubin, which is really jaundice. After careful questioning, he had some loss of appetite and abdominal discomfort during this period, but he had no fever and no abdominal pain.

Could it be hepatitis? I remember when I was in school, my roommate had hepatitis A, and his face was covered with jaundice. I was very worried that I would be infected, so I still remember it clearly. I remember that classmate had nausea, vomiting, and general fatigue, which was much more serious than Lao Wang's.

Or diseases like gallstones, which are indeed common, but most of these diseases are accompanied by symptoms such as abdominal pain.

At this time, I suddenly had a flash of inspiration and thought of another disease. Could it be this? Because Lao Wang is a heavy smoker, and this disease is actually related to smoking. I immediately wrote him an ultrasound order and asked him to do an upper abdominal ultrasound. On the order, I deliberately wrote: Please pay attention to the pancreas. Not long after, Lao Wang came back and got the report, which clearly said: Pancreatic MT is possible. This ultrasound confirmed my judgment: Lao Wang is most likely suffering from pancreatic cancer.

I later referred Lao Wang to a colleague in surgery, and the final result was indeed pancreatic cancer.

How can pancreatic cancer be related to smoking? The pancreas is an organ hidden deep in the abdominal cavity. It is not like the lungs, which are directly stimulated by smoke, nor is it like the bladder, where the metabolites of smoke accumulate in the urine and stimulate the bladder wall, leading to the occurrence of tumors.

But in fact, since the 1980s, many studies have confirmed that smoking is an important cause of pancreatic cancer. In 1991, Ghadirian et al. reported that smoking and pancreatic cancer have a significant positive correlation [1]. A 1996 study found that smokers are 2.5 times more likely to develop pancreatic cancer than non-smokers [2]. In 2004, a study on pancreatic cancer risk factors conducted by our National Changzheng Hospital suggested that smoking is an important behavioral risk factor for pancreatic cancer, especially young age of smoking and heavy smoking are closely related to the incidence of pancreatic cancer [3]. However, it is still unclear what causes smoking to cause pancreatic cancer. Some reports believe that certain gene mutations cause susceptibility in this regard. For example, the loss of the GSTT1 gene is related to smoking-induced cancer. Smokers whose family members develop pancreatic cancer before the age of 60 have a 7-fold increased risk of pancreatic cancer compared to non-smokers with no family history. In addition to active smoking, some studies have even found that passive smoking is also related to the occurrence of pancreatic cancer [4]. So no matter what the underlying mechanism is, the fact that smoking is a risk factor for pancreatic cancer is irrefutable. In this case, I would like to advise all smokers to quit smoking as soon as possible.

References:

[1]Fleiss j1, Gross AJ. Meta—analysis in epidemiology. with special reference to studies of the association between exposure to environmental tobacco smoke and lung cancer: a critique. J

CIin Epidemiol, l99l, 44: l27-l39.

[2] Fuchs CS . A Prospective Study of Cigarette Smoking and the Risk of Pancreatic Cancer[J]. Archives of Internal Medicine, 1996, 156(19):2255-2260.

[3] Shi Jian, Wu Cheng, Liu Su, et al. Meta-analysis of some risk factors for pancreatic cancer in my country[J]. Chinese Journal of Pancreatology, 2004, 4(3):154-158.

[4] Bao Y, Giovannucci E, Fuchs CS, et al. Passive Smoking and Pancreatic Cancer in Women: a Prospective Cohort Study[J]. Cancer epidemiology, biomarkers & prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 2009, 18(8):2292.

Author: Shanghai Fengxian District Central Hospital

Liu HongweiChief Physician