Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and a leading cause of cancer-related deaths worldwide. Cirrhosis remains the most significant risk factor, with hepatitis B and C being independent risk factors for cirrhosis development. Alcohol consumption is another important risk factor, particularly in the United States where it is five times more prevalent than hepatitis C. Diagnosis is confirmed without pathologic confirmation, and screening includes radiologic tests (ultrasound, CT, MRI) and serological markers (α-fetoprotein). Treatment options include orthotopic liver transplantation (OLT), surgical resection, transarterial chemoembolization, radiofrequency ablation, microwave ablation, percutaneous ethanol injection, cryoablation, radiation therapy, systemic chemotherapy, and molecularly targeted therapies. OLT is curative for eligible patients, but organ shortage limits its availability. Early diagnosis and appropriate screening are crucial for improving outcomes, as HCC often presents in advanced stages. Preventive measures such as HBV vaccination, universal blood product screening, safe injection practices, and antiviral therapy can significantly reduce HCC incidence. Advances in surgical and nonsurgical treatments have improved overall survival, but challenges remain, including organ shortage and the need for further biomarker research.Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and a leading cause of cancer-related deaths worldwide. Cirrhosis remains the most significant risk factor, with hepatitis B and C being independent risk factors for cirrhosis development. Alcohol consumption is another important risk factor, particularly in the United States where it is five times more prevalent than hepatitis C. Diagnosis is confirmed without pathologic confirmation, and screening includes radiologic tests (ultrasound, CT, MRI) and serological markers (α-fetoprotein). Treatment options include orthotopic liver transplantation (OLT), surgical resection, transarterial chemoembolization, radiofrequency ablation, microwave ablation, percutaneous ethanol injection, cryoablation, radiation therapy, systemic chemotherapy, and molecularly targeted therapies. OLT is curative for eligible patients, but organ shortage limits its availability. Early diagnosis and appropriate screening are crucial for improving outcomes, as HCC often presents in advanced stages. Preventive measures such as HBV vaccination, universal blood product screening, safe injection practices, and antiviral therapy can significantly reduce HCC incidence. Advances in surgical and nonsurgical treatments have improved overall survival, but challenges remain, including organ shortage and the need for further biomarker research.