Progress in the management of hepatocellular carcinoma (HCC) has been slow and has limited impact on outcome. Most patients with HCC have two diseases--chronic liver disease and HCC--and complex interactions between the two have major implications for diagnosis and prognosis as well as the management of HCC. The disease is most prevalent in those areas of the world where the infrastructure for clinical trials is least developed. Also, the aetiology of the disease varies around the world and it is still not known whether HCCs of different aetiologies have different prognoses. Current treatment is making an impact on the management of HCC but further progress awaits not only the development of more effective treatments but also the development of adequate methodologies to assess the impact of these treatments.