The medical oncologist’s perspective on hepatocellular carcinoma (HCC) is unique compared with their view on other solid tumors. A patient’s underlying liver function should be factored into the selection of treatment options; therefore, a staging system that takes into account other clinical parameters other than only tumor characteristics is important. Sorafenib is currently the only FDA-approved chemotherapy drug for patients with HCC based on the data from the SHARP trial. It is important for oncologists to anticipate and treat the side effects of sorafenib treatment in order to help the patients continue the treatment. In addition, it is important to design clinical trials for HCC that have meaningful endpoints to improve our care for patients with HCC.