Patients with hepatocellular carcinoma with visible thrombus in the vasculature may receive systemic anticancer therapy such as chemotherapy. According to the guideline, patients with hepatocellular carcinoma with thrombus in the vasculature have at least CNLC stage IIIa (PS 0-2 points, liver function Child-Pugh A/B grade, tumor status regardless, with imaging visible vascular thrombus without extra-hepatic metastasis), and systemic anti-tumor therapy, TACE, surgical resection, and radiotherapy are recommended for this group of patients. The first line of systemic antitumor therapy is chemotherapy (FOLFOX4), targeted therapy or immunotherapy (atilizumab + bevacizumab, sindilizumab + bevacizumab analogs; doxorafenib, lenvatinib, sorafenib, etc.). If there is extrahepatic metastasis, it is IIIb, and systemic anticancer therapy, TACE, radiotherapy, etc. are recommended; If the liver function is Child-Pugh grade C, then chemotherapy is not recommended and symptomatic supportive therapy, liver transplantation, palliative care, etc. are feasible. In conclusion, the treatment plan for liver cancer patients needs to be based on the condition. It is recommended to go to regular hospitals to evaluate the condition and follow the doctor’s instructions to avoid delaying the condition.