Hepatobiliary diseases in the cancer patient leading to critical illness

Cancer patients represent a special subset of population prone to a plethora of adverse effects, secondary to cancer or cancer therapy. Among the most notable adverse effects are those which cause insult to the hepatobiliary system. This subset of adverse effects is particularly concerning as it can delay lifesaving cancer therapy. Interestingly, such lifesaving cancer therapy often is the culprit of hepatobiliary disease among cancer patients. Exceptions to this generalization are hepatic and pancreatobiliary malignancies leading to malignant biliary obstruction, hepatic tumor rupture, or liver failure. Cancer metastases affecting the hepatobiliary system can produce a similar picture. Often such hepatobiliary disease can be difficult to manage and necessitate, at least in part, management in the intensive care (ICU) unit. However, there are no well-defined pathways for optimal ICU care for this patient population and represent a major knowledge gap that requires to be filled urgently. This chapter deals with hepatobiliary disease that is commonly encountered in cancer patients and may necessitate intensive management.