Hepatocellular carcinoma (HCC) is a challenging malignancy of global importance, it is associated with a high rate of mortality and its prevalence in the United States and in Western Europe is increasing. Cirrhosis is the strongest and the most common known risk factor for hepatocellular carcinoma, particularly cirrhosis related to hepatitis C virus (HCV) and hepatitis B virus (HBV) infections. The stage of cancer dictates the therapeutic choice, making early detection a primary objective. Early diagnosis of hepatocellular carcinoma is feasible because HCC develops in the background of well-known, readily identifiable and potentially avoidable environmental risk factors. Many observational studies have reported that HCC is diagnosed at an earlier stage in patients who received surveillance. Current guidelines advocate the use of abdominal ultrasound (US) at 6-12 months frequency to screen for HCC in high-risk patients. The use of AFP alone is strongly discouraged, and its use in addition to US is controversial. Patients with abnormal screening tests require additional investigation. Although the optimal methods of screening and the cost-effectiveness of surveillance for HCC remain to be established, systematic screening still offers the best hope for early diagnosis, treatment eligibility, and improved survival.