Diagnosis and Treatment

At Providence Saint John’s Health Center we are committed to diagnosing and treating liver cancer, always with a goal of developing more effective therapies. We evaluate many patients each year with primary liver cancer, and use every means at our disposal to treat hepatocellular carcinoma, which arises in liver cells known as hepatocytes, and cholangiocarcinoma that begins in the bile ducts within the liver.

We also treat many types of benign liver tumors well as a rare type of liver cancer called fibrolamellar-hepatocellular carcinoma.

In order to reach a diagnosis for liver, biliary, or pancreatic disorders, we take a thorough medical history in order to be as accurate as possible. We’ll ask questions and make note of any symptoms you may have experienced as well any other pertinent information.

A physical examination is also done to help assess the problem more completely.

Diagnosing liver cancer or metastatic liver cancer may include one or more of the following:

  • Abdominal ultrasound or sonography
    This diagnostic imaging technique uses high-frequency sound waves to create an image of your internal organs such as the liver, spleen, and kidneys and to assess blood flow through various vessels.
  • Computed tomography scan (CT or CAT scan)
    This diagnostic imaging procedure uses a combination of X-rays and computer technology to produce very detailed images – often called slices – of the body, including the organs.
  • Endoscopic retrograde cholangiopancreatography (ERCP)
    This procedure allows the gastroenterologists at Saint Johns to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. The procedure combines X-ray and the use of an endoscope, a long, flexible, lighted tube. The scope is guided through the patient's mouth and throat, then through the esophagus, stomach, and duodenum. The doctor can examine the inside of these organs and detect any abnormalities. A tube is then passed through the scope, and a dye is injected which will allow the internal organs to appear on an X-ray. Stents or shunts can be placed to relieve blocked bile ducts.
  • Esophagogastroduodenoscopy (also called EGD or upper endoscopy)
    This allows your doctor to examine the inside of the esophagus, stomach, and duodenum. A thin, flexible, lighted tube, called an endoscope, is guided into the mouth and throat, then into the esophagus, stomach, and duodenum. The endoscope allows the doctor to view the inside of this area of the body, as well as to insert instruments through a scope for the removal of a sample of tissue for biopsy if a biopsy is deemed necessary.
  • Laparoscopy
    This diagnostic test uses a viewing tube with a lens or camera and a light on the end, which is inserted through a small incision in the abdomen, to examine the contents of the abdomen and remove tissue samples.
  • Liver biopsy
    This procedure takes tissue samples from the liver with a needle or during surgery for examination under a microscope.
  • Liver function tests
    This is a series of special blood tests that can determine if the liver is functioning properly.
  • Magnetic resonance cholangiopancreatography (MRCP)
    This is a special type of MRI that uses radio waves and magnets to obtain pictures of the bile ducts and internal organs.
  • Magnetic Resonance Imaging (MRI)
    This imaging modality uses a powerful to find tumors in the liver. This is often more sensitive than CT scans for primary liver cancer especially in patients with cirrhosis.
  • Percutaneous transhepatic cholangiography (PTC)
    A needle is introduced through the skin and into the liver where a dye is deposited so the bile duct structures can then be viewed by X-ray.
  • X-ray
    This diagnostic test uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.


Our treatment plans are tailored to each patient, always with the goal of eliminating liver tumors and improving your quality of life. Treatment plans may include one or a combination of treatments, including minimally invasive procedures, chemotherapy and biologic therapy, or radiation therapy. We have one of the largest experiences in the world treating liver cancers and have been instrumental in developing novel and more effective treatments.

Once a diagnosis has been established, additional tests may be required to determine the extent, or stage, of the tumor and the presence of other liver conditions, such as hepatitis, cirrhosis, and diabetes, all of which can affect the choice and outcome of treatment.

Specific treatment for liver cancer will be determined by your doctor based on:

  • Your age, overall health, and medical history
  • Extent of the disease
  • Your tolerance of specific medicines, procedures, or therapies
  • Expectations for the course of the disease
  • Your opinion or preference

We will sit with you and discuss the options available so that you can be as informed as possible when making the decision.

Treatment for liver cancer may include:

  • Surgery
    Removal of the tumor offers the best chance for cure. Surgery can be performed using minimally invasive techniques (laparoscopy) and many patients are discharged home the day after surgery. Up to 60 percent of patients with colon cancer liver metastases can be cured with a combination of surgery and more modern chemotherapy. Dr. Bilchik at the Providence Saint John’s Health Center was among the first in the country to perform radiofrequency ablation of liver tumors and more recently microwave ablation.
  • Radiation therapy
    Radiation therapy uses high-energy rays to kill or shrink cancer cells.
  • Chemotherapy
    Chemotherapy uses anticancer drugs to kill cancer cells. Many novel chemotherapy regimens and combination with biologic therapy have been shown to be very effective in making tumors smaller and thereby allowing surgical removal.

Treatment for metastatic liver cancer is much the same, and will depend on where the primary cancer was located. It may also include surgery, radiation therapy and chemotherapy, or a combination of all.

  • Minimally-invasive techniques
    Our surgeons often use minimally invasive surgical techniques to determine the extent of the cancer and whether it has spread outside of the liver. Doctors insert a laparoscope — a thin, lighted tube with a camera at its tip — through a tiny incision in the patient's abdomen to view the liver and surrounding areas.

    Many liver tumors can be surgically removed, known as resected, using a laparoscope and other minimally invasive instruments, which can reduce discomfort, speed up recovery time, and reduce the length of stay in the hospital as compared with traditional surgery. Providence Saint Johns’ surgeons were among the first to use laparoscopic techniques in the treatment of liver cancer. Ultrasound can also be performed laparoscopically which is the most sensitive modality to detect even the smallest liver tumors.
  • Embolization
    This works to shrink tumors by blocking their supporting blood vessels. Sometimes the blood flow to one of the portal veins can be blocked to allow the other lobe of the liver to grow. This is known as portal vein embolization and the opposite lobe of the liver can grow an additional 15 percent in just six weeks, allowing more extensive removal of liver tumors without risk of liver failure.
  • Thermal ablation
    Uses heat, cold, microwave or electrical currents to destroy tumor cells. Providence Saint John’s has extensive experience destroying tumor via freezing (cryosurgery) or heat (radiofrequency or microwave ablation). These procedures are typically reserved for those patients that are not amenable to resection. Ablation can be performed under CT scan, ultrasound or laparoscopic guidance allowing for outpatient surgery.