Hepatocellular carcinoma (HCC) is a primary malignancy of the liver, often associated with cirrhosis, which is present in 90% of cases. Diagnosing HCC relies on imaging techniques, including CT, MRI, and contrast-enhanced ultrasound, in patients with cirrhosis or hepatitis B, while biopsy is required in other populations. Although traditionally used, alpha-fetoprotein (AFP) levels are not elevated in about 40% of HCC patients. Risk factors for HCC include hepatitis B virus (HBV) infection globally and hepatitis C virus (HCV) in the USA, with nonalcoholic fatty liver disease (NAFLD) also contributing. Staging systems such as TNM and Barcelona Clinic Liver Cancer (BCLC) guide treatment strategies, though none are universally adopted. Treatment options range from curative resection and liver transplantation to locoregional therapies like ablation and transarterial chemoembolization, with systemic therapies available for advanced disease. Newer treatment modalities, including immunotherapy and targeted therapies, are showing promise in clinical trials. Early detection through screening in high-risk populations remains critical for improving outcomes. Continued research into diagnostic markers, particularly for AFP-negative cases, and the refinement of treatment protocols are essential to advancing the management of HCC. This chapter will equip new surgical faculty with essential considerations for navigating the complex decision-making process of managing HCC patients.