Hepatocellular carcinoma (HCC) is a primary liver malignancy commonly encountered in the setting of chronic liver disease and cirrhosis. Survival in HCC is determined by the ABCs: (A) anatomic stage; (B) biologic grade; and (C) cirrhosis severity. Improvement of imaging techniques permits clinicians to accurately diagnose HCC without biopsy confirmation. Advances in surgical and therapeutic options have improved treatment response and survival. Surgical resection, liver transplant, and thermal ablation in selected patients can potentially cure HCC. Noncurative approaches including intraarterial, radiation, and systemic therapies aim to palliate or slow the progression of disease. Management of HCC is complex, and the choice of treatment approach is enhanced by multidisciplinary consensus, including a liver transplant center.