Metabolic-dysfunction-associated steatotic liver disease (MASLD, previously known as non-alcoholic fatty liver disease) is a growing global health concern, characterized by excessive fat accumulation in the liver, which can lead to liver inflammation, chronic liver disease, and hepatocellular carcinoma (HCC). The condition is particularly prevalent among overweight or obese individuals and those with type 2 diabetes. HCC often develops at an earlier stage of liver disease in MASLD patients, complicating risk-stratification and treatment strategies. Research is ongoing to understand why some patients develop cancer earlier and how to optimize treatment responses, which vary based on the initial cause of liver inflammation. Therapeutic approaches include lifestyle modifications, diabetes management, and pharmacological interventions, such as PPARγ agonists and GLP-1 receptor agonists. However, the lack of specific biomarkers and the complexity of MASLD-HCC make patient stratification and personalized treatment challenging. Future research should focus on developing validated scoring systems for early detection and targeted therapies to improve outcomes in MASLD-HCC patients.Metabolic-dysfunction-associated steatotic liver disease (MASLD, previously known as non-alcoholic fatty liver disease) is a growing global health concern, characterized by excessive fat accumulation in the liver, which can lead to liver inflammation, chronic liver disease, and hepatocellular carcinoma (HCC). The condition is particularly prevalent among overweight or obese individuals and those with type 2 diabetes. HCC often develops at an earlier stage of liver disease in MASLD patients, complicating risk-stratification and treatment strategies. Research is ongoing to understand why some patients develop cancer earlier and how to optimize treatment responses, which vary based on the initial cause of liver inflammation. Therapeutic approaches include lifestyle modifications, diabetes management, and pharmacological interventions, such as PPARγ agonists and GLP-1 receptor agonists. However, the lack of specific biomarkers and the complexity of MASLD-HCC make patient stratification and personalized treatment challenging. Future research should focus on developing validated scoring systems for early detection and targeted therapies to improve outcomes in MASLD-HCC patients.