Primary biliary cholangitis (PBC) — previously called primary biliary cirrhosis — is a chronic, or long-term liver disease. This ongoing condition causes inflammation and damage to the liver. If you have PBC, you may wonder if damage to your liver could lead to other illnesses, like liver cancer.

PBC progression cannot be reversed, and many symptoms of PBC can be similar to those of other serious diseases. It’s important to understand how PBC progresses and what risk factors could affect your health in the future.

This article will discuss the links between PBC and liver cancer, including how PBC progression can affect your risk, ways to prevent it, and the signs and symptoms of liver cancer.

How PBC Progresses

PBC is caused by chronic inflammation in the bile ducts of the liver. This inflammation often happens when the body tries to fight off bacteria and viruses. However, when inflammation is chronic and overactive, it can cause tissue damage. In PBC, the immune system mistakenly attacks healthy cells instead of sick cells. This eventually leads to liver damage.

Autoimmune diseases develop when the immune system attacks the body’s healthy cells. Other examples of autoimmune diseases include lupus and psoriasis. People with autoimmune diseases may have a higher risk of developing cancer.

The inflammation from PBC affects the bile ducts. Bile ducts deliver bile from the liver — where bile is made — to other organs. Bile is essential for digestion, vitamin absorption, and detoxification. When the bile ducts are damaged, bile cannot flow properly. Over time, bile builds up in the liver and causes more inflammation. This inflammation can damage more liver cells, resulting in cell death and the formation of scar tissue. This scarring is called fibrosis. As more healthy tissue is replaced by fibrosis, the liver no longer works as it should. This leads to a condition known as cirrhosis.

The progression of PBC is broken up into four stages, also known as histologic stages. These stages describe how much the liver is damaged, focusing on how much fibrosis is present. Stage 1 is the earliest and least severe. The last stage, stage 4, is when cirrhosis happens.

How Inflammation From PBC Can Cause Liver Cancer

Cancer happens when cells grow out of control and form cancerous masses called tumors. This can happen when changes to DNA — known as mutations — occur in cells. DNA is like an instruction manual that tells cells how to function. When DNA mutations happen, the instructions can go wrong and make cells act abnormally.

Liver cancer starts in liver cells. Hepatocellular carcinoma (HCC) is the most common type of liver cancer. The risk of getting HCC increases with long-term liver inflammation, which can lead to cirrhosis. This creates an environment where tumors are more likely to form.

This link between liver inflammation and HCC isn’t only seen in PBC. It can also happen to people with other conditions that cause liver fibrosis and cirrhosis. People living with persistent hepatitis virus infections also have liver inflammation that leads to an increased risk of liver cancer.

Chronic inflammation has been linked to cancer since the 1860s. While we know that chronic inflammation can lead to cancer, researchers are still trying to figure out exactly how chronic inflammation and cirrhosis can lead to HCC.

PBC and Cancer Risk

Compared to the general population, people with PBC have a higher risk of developing HCC. One study found that people living with PBC have a 4 percent chance of developing HCC over the following 10 years.

Different studies have reported various rates of HCC in people with PBC, ranging from 0.7 percent to 16 percent. People with PBC were also found to have a 10-year risk of 4 percent for developing HCC. In contrast, the Centers for Disease Control and Prevention (CDC) says that liver cancer affects only 0.02 percent of the general population. It’s important to note that the general population data includes other types of liver cancers too, not just HCC.

One study looked at results from other studies on PBC and HCC. The authors found that PBC is strongly linked to a higher risk of both overall cancer and HCC.

Not everyone living with PBC has the same risk of cancer. People at higher risk of developing cancer include:

• Older adults
• Males
• Those with type 2 diabetes or viral hepatitis
• Those with more advanced stages of PBC
• Those who did not respond to PBC treatments like ursodeoxycholic acid (UDCA)

The most important risk factor for liver cancer is the level of liver damage. For example, people living with PBC who have cirrhosis are more likely to develop HCC than those with PBC who do not have cirrhosis.

Preventing Liver Cancer for People With PBC

Having PBC with cirrhosis and PBC at more advanced stages are risk factors for developing liver cancer. If you have PBC, starting treatment can help slow your progression to more advanced stages. Some studies have shown that treatment with UDCA may lower the risk of liver cancer, likely by slowing this progression. If you’re living with PBC with cirrhosis, experts recommend getting screened for liver cancer every six months.

There are other steps you can take to lower your cancer risk. These recommendations aren’t just for people living with PBC. The CDC recommends the following preventive steps:

• Maintaining a healthy weight
• Receiving the hepatitis B vaccine
• Getting tested for hepatitis C
• Quitting smoking (if you smoke)
• Limiting alcohol consumption

Be sure to discuss these options with your primary care or hepatology provider to find what might work best for you.

Signs and Symptoms of Liver Cancer

If you’re worried about getting liver cancer, knowing the signs and symptoms can be helpful. According to the Mayo Clinic, these are some of the signs and symptoms of liver cancer:

• Unintentional weight loss
• Loss of appetite
• Nausea and vomiting
• Increased tiredness
• Pain in the upper abdomen
• Swelling of the abdomen
• Yellowing of the skin and whites of eyes (jaundice)
• White or chalky stools

Many of the symptoms above can also be caused by other illnesses. If you notice any signs that could indicate liver cancer, it’s important to follow up with your doctor about your next steps.

Find Your Team

On myPBCteam, the social network for people with primary biliary cholangitis and their loved ones, more than 1,500 members come together to ask questions, give advice, and share tips with others who understand life with primary biliary cholangitis.

Have you or a loved one been diagnosed with PBC and liver cancer? Have you tried any preventive measures for liver cancer? Share your experiences in the comments below, or start a conversation by posting on your Activities page.