Hepatitis and cirrhosis are the main causes of giant hepatic sarcomatoid carcinoma. Early stage of giant hepatic sarcomatoid carcinoma often has no special signs and symptoms, and patients often seek medical attention because of the discovery of an upper abdominal mass. As the disease progresses, liver pain, fatigue, nausea, vomiting, anorexia, weight loss, epigastric mass and gastrointestinal symptoms may appear. In advanced stages, jaundice, ascites and malignancy may be present. Larger hepatic hemangiosarcoma may rupture and bleed. In case of giant hepatic sarcomatoid carcinoma, partial hepatic lobectomy is feasible after assessment that the volume of remaining liver tissue may be large, liver function is good, no ascites, jaundice, normal coagulation function and albumin level. If surgery is not possible due to poor liver function, interventional embolization, i.e. chemotherapeutic drug infusion therapy, postoperative chemotherapy such as gemcitabine combined with cisplatin, targeted therapy such as sorafenib or levatinib, and immunotherapy such as pembrolizumab can be chosen. Some patients can achieve the indication for surgery after systemic treatment, and then surgical resection can also achieve good results. If the general condition is poor and cannot tolerate substantial treatment such as surgery, interventional embolization, chemotherapy, etc., conservative and supportive treatment should be given. Specific medication and treatment should be under the guidance of a physician.