Obstructive jaundice and biliary obstruction

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.