Background <p>Hepatocellular carcinoma (HCC) is one of the most common causes of cancer-related deaths worldwide and usually develops as a&#xa0;result of liver cirrhosis (LC). Tumor diagnosis, limited treatment options, poor prognosis and complications such as ascites can mentally affect these patients: however, data on mental distress in HCC patients in Germany are limited. The aim of this study was to investigate the frequency and severity of anxiety and depression symptoms in HCC patients compared to LC patients and to analyze the influence of the treatment status and ascites on the anxiety and depressive symptoms.</p> Material and methods <p>Data from 35 HCC and 104 LC patients were evaluated. Clinical data on the etiology, the treatment situation (initial diagnosis, post-local ablative treatment or tumor recurrence), and the presence of clinical ascites were extracted from patient records. Mental well-being was assessed using the Hospital Anxiety and Depression Scale (HADS). Group comparisons were performed using t‑tests, Mann-Whitney tests and χ²/Fisher tests.</p> Results <p>Of the HCC patients 35% showed relevant mental distress. Excessive anxiety symptoms were found in 10% and depressive symptoms in 7%. Untreated patients were more severely affected (42%) than those who had undergone local ablative treatment (0%) or had a&#xa0;recurrence (25%). Ascites did not influence mental well-being in HCC. There were no differences compared to LC but ascites was associated with higher depression scores and increased mental stress in LC.</p> Conclusion <p>Mental stress affects around one third of HCC patients in an outpatient setting, comparable to inpatient data. The burden is particularly high before the start of treatment. In LC patients, ascites in particular have an impact on mental health. The results emphasize the need for early systematic screening and guideline-based psycho-oncological interventions.</p>