Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths, often resulting from cirrhosis. The molecular pathogenesis is complex and heterogeneous, but current molecular information has not significantly impacted treatment decisions. Periodic surveillance imaging is widely practiced for early detection, and effective treatments are available for early-stage tumors. Treatment options include resection, transplantation, radiofrequency ablation, transarterial chemoembolization, and radioembolisation. Sorafenib remains the best-supported systemic therapy for advanced disease. Despite ongoing research, new trials are needed to assess sequential or combined therapies. The article discusses the challenges in molecular classification, risk stratification, and treatment strategies for HCC, emphasizing the need for personalized medicine and the integration of genetic and microenvironmental factors.Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths, often resulting from cirrhosis. The molecular pathogenesis is complex and heterogeneous, but current molecular information has not significantly impacted treatment decisions. Periodic surveillance imaging is widely practiced for early detection, and effective treatments are available for early-stage tumors. Treatment options include resection, transplantation, radiofrequency ablation, transarterial chemoembolization, and radioembolisation. Sorafenib remains the best-supported systemic therapy for advanced disease. Despite ongoing research, new trials are needed to assess sequential or combined therapies. The article discusses the challenges in molecular classification, risk stratification, and treatment strategies for HCC, emphasizing the need for personalized medicine and the integration of genetic and microenvironmental factors.