Which cancer most commonly presents with painless jaundice?

• A. Pancreatic cancer
• B. Lung cancer
• C. Gastric cancer
• D. Colon cancer

Answer: (A)

Painless obstructive jaundice is most characteristic of cancer in the head of the pancreas. When a mass grows there, it often compresses the distal common bile duct, causing bile to back up into the liver. This leads to conjugated (direct) hyperbilirubinemia with jaundice that is typically painless, and you may see dark urine and pale stools. Weight loss and a palpable, non-tender gallbladder (Courvoisier sign) can accompany this scenario.

Other cancers can cause jaundice if they involve the liver or biliary system, but the classic painless jaundice pattern points to a pancreatic head tumor rather than the others listed. Lung, gastric, or colon cancers would more often present with their primary GI or metastatic features, or with jaundice only if there is liver involvement, which is not the typical presentation.