Hepatocellular carcinoma (HCC) is associated with a historical 5-year survival rate of less than 5%. Evidence suggests that the incidence of HCC is rising in several countries, including the US. Current curative treatment options for HCC include surgical resection and liver transplantation, but these approaches are restricted to carefully selected patients who may benefit from such interventions. Other curative options include ablative therapies, which destroy tumor cells via the injection of chemical substances, radiation, or heating or cooling. Patients with more advanced HCC may be candidates for noncurative treatments, including transarterial embolization and transarterial ablative therapy with beads impregnated with radiation-emitting substances - if the tumor has not invaded vessels or disseminated outside the liver. New therapeutic approaches include Raf kinase inhibitors, such as sorafenib. Other treatments under investigation include immunotherapy, tyrosine kinase receptor inhibitors, and treatments arising from technical advances in ablation and radiation. These new approaches may help to address the enormous need for expanded treatment options for patients with HCC.