Hepatocellular carcinoma (HCC) is the fifth most common cancer in men and eighth most common cancer in women worldwide. Its crude incidence in the European Union is 8.29/ 100 000. Areas such as Asia and sub-Saharan Africa with high rates of infectious hepatitis have incidences as high as 120 cases per 100 000. It is 4–8 times more common in men and usually associated with chronic liver injury (hepatitis B, hepatitis C and alcoholic cirrhosis). Chronic infection with hepatitis B virus in the setting of cirrhosis increases the risk of hepatocellular carcinoma 1000-fold. Some 5–30% of individuals with HCV infection develop chronic liver disease, about 30% progress to cirrhosis, and in these, 1–2% per year develop hepatocellular carcinoma. Coinfection with HBV further increases the risk. Alcohol abuse in the setting of chronic HCV infection doubles the risk of hepatocellular carcinoma compared with HCV infection alone. Median age at diagnosis is between 50 and 60 years. In Africa and Asia, age at diagnosis is substantially younger, occurring in the fourth and fifth decades of life, respectively.