Hepatocellular carcinoma remains one of the commonest malignant tumours in the world. It usually arises on a background of hepatic cirrhosis which limits the possibility of resection or transplantation. The literature contains few good randomised trials of therapy for this common tumour. This review discusses the role of surgery and liver transplantation together with recent developments in medical therapy, namely chemoembolisation, percutaneous ethanol injection and hormonal treatment, and arrives at a consensus as to the place of these treatments in the current management of hepatoma.