The vast majority of HCC in Western Australia is managed by hepatologists in a tertiary centre. Management is complex, primarily due to the competing interplay of three concurrent diseases: HCC, cirrhosis of varying severity, and the underlying liver disease. Management algorithms (such as BCLC and HKLC) are broad guidelines only and cannot account for the vast array of individual variation in disease that are encountered (anatomical / tumoral / biochemical / psychoscocial). Here I will give you an overview of how we manage HCC in a tertiary setting.