The management of hepatocellular carcinoma (HCC) has evolved since the 2005 AASLD guidelines. New data has led to updates in surveillance, diagnosis, staging, and treatment. Surveillance is cost-effective for patients with high HCC risk, defined as 1.5% per year for hepatitis C and 0.2% per year for hepatitis B. Ultrasound is recommended for surveillance every 6 months. Diagnosis should use imaging or biopsy, with dynamic contrast-enhanced ultrasound validated. Contrast-enhanced ultrasound may falsely identify HCC in cholangiocarcinoma, so it is no longer recommended. The BCLC staging system is widely accepted for treatment decisions. Liver transplantation remains a first-line option for patients with optimal profiles. Radiofrequency ablation is effective for small lesions, but sorafenib is now first-line for advanced HCC. Sorafenib improves survival and is well-tolerated, with common side effects including diarrhea and hand-foot skin reaction. HCC has transitioned from a death sentence to a preventable and treatable disease, requiring high-quality screening and appropriate management.The management of hepatocellular carcinoma (HCC) has evolved since the 2005 AASLD guidelines. New data has led to updates in surveillance, diagnosis, staging, and treatment. Surveillance is cost-effective for patients with high HCC risk, defined as 1.5% per year for hepatitis C and 0.2% per year for hepatitis B. Ultrasound is recommended for surveillance every 6 months. Diagnosis should use imaging or biopsy, with dynamic contrast-enhanced ultrasound validated. Contrast-enhanced ultrasound may falsely identify HCC in cholangiocarcinoma, so it is no longer recommended. The BCLC staging system is widely accepted for treatment decisions. Liver transplantation remains a first-line option for patients with optimal profiles. Radiofrequency ablation is effective for small lesions, but sorafenib is now first-line for advanced HCC. Sorafenib improves survival and is well-tolerated, with common side effects including diarrhea and hand-foot skin reaction. HCC has transitioned from a death sentence to a preventable and treatable disease, requiring high-quality screening and appropriate management.