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Hepatocellular carcinoma (HCC) is a major health problem worldwide and especially in the Asia-Pacific region, with high incidence and mortality rate. The risk factors are well known, and there is increasing understanding of the mechanism of hepatocarcinogenesis. Despite improvements in management of HCC over the past two decades through advances in imaging techniques, surgery and perioperative care, HCC remains a major challenge. Recurrence rate remains high, and there is as yet no effective treatment for inoperable cases that represent the vast majority of patients. The future will lie in the development of new preventive and therapeutic strategies, perhaps in combination with current surgical and non-surgical treatment options, through better understanding of the molecular basis of hepatocarcinogenesis.