Hepatocellular carcinoma (HCC) is one of the leading tumors for cancer deaths worldwide and the leading cause of death in patients with cirrhosis. the incidence of HCC is increasing in Europe and the United States. In Asia and Africa, HBV infection is the main risk factor, while in Western countries and Japan, it is HCV infection, alcohol abuse and non-alcoholic fatty liver disease. The increased incidence of HCC in certain regions of the world and the success of early diagnosis and effective treatment have drawn the attention of all fields related to HCC research and clinical treatment. I. Diagnosis and staging of HCC The diagnosis of HCC with cirrhosis can be established by biopsy or non-invasive criteria of tumor arterial blood supply enhancement. The diagnosis of HCC can be established by non-invasive criteria such as biopsy or enhancement of tumor arterial blood supply. Alpha-fetoprotein (AFP) is also elevated in viral invasion and other malignancies such as cholangiocarcinoma, and its sensitivity and specificity are not yet adequate. Prognostic factors for survival in HCC are well defined and certain classifications have been proposed. Those that address solely the degree of hepatic impairment [Child-Pugh stage, Model for End-Stage Liver Disease score (MELD)] or tumor classification (TNM) cannot correctly determine prognosis, and some classification systems do not take into account tumor-related symptoms. The Barcelona Liver Cancer (BCLC) staging system, which takes into account three factors: tumor, liver function and systemic status, while linking to prognosis and treatment options, has gained wide approval, including recognition by academic institutions such as the American Association for the Study of Liver Diseases (AASLD). II. HCC Treatment Options and Current Challenges HCC can be broadly classified into three groups: (1) those who can benefit from surgical or locoregional treatment, whose main problem is the prevention and management of relapse. (2) Those who are not suitable for radical treatment but can benefit from medical therapy. (3) Severe impairment of liver function or severe deterioration of systemic condition (ECOG score >2), for which only symptomatic palliative treatment is appropriate. The first group of patients was from stage A of BCLC staging, the third group corresponded to stage D, while the second group included a wider range of hepatic impairment (Child-Pugh A or B), tumor masses (vascular invasion, extrahepatic dissemination) and the presence or absence of symptoms. These patients were accordingly classified as moderate BCLC-stage B (no vascular invasion, no dissemination, no symptoms) and progressive BCLC-stage C (anything to the contrary). Stage A patients are amenable to surgical resection, liver transplantation, or ablative therapy, with the main challenges being the management of patients awaiting liver transplantation and the prevention of recurrence after previously successful treatment. stage B patients may benefit from percutaneous arterial chemoembolization therapy, with the main consideration being how to enhance the efficacy and maintain it over time. stage C patients have no effective treatment and are available for clinical trial studies to evaluate new drugs. Some studies have shown chemotherapy to be ineffective, and the same is true for interferons, anti-androgens, estrogen blockers and seocalcitol. The past decade has seen further understanding of the molecular biology of hepatocarcinogenesis and tumor progression. Although it is a complex multi-step process, certain important intracellular signaling pathways such as Ras/Raf-MEK/ERK and PI3K/Akt/mTOR are well defined. The role of certain growth factors and anti-angiogenic factors —- epidermal growth factor (EGF) and vascular endothelial growth factor (VEGF) —- is well established. Drugs targeting single or multiple molecular abnormalities are in development, and some of them are already in clinical trials. Recent data affirm the efficacy of sorafenib (a multi-kinase inhibitor targeting Ras/Raf/VEGF2/c-kit/PDGFR) in prolonging survival. Third, HCC enters the era of molecularly targeted therapies Depending on their targets, different drugs can be classified as those targeting signal transduction (by blocking one or more growth factor receptors and/or intracellular signals) and those targeting angiogenesis, apoptosis, cell cycle, cell migration, or protein transformation. This classification is artificial and most drugs do not specifically target a single target or pathway. These targeted drugs are mainly specific ligands for cell surface receptors (antibodies) and protein kinase inhibitors.