All the cases of proven hepatocellular carcinoma seen at Westmead Hospital, Sydney between January 1980 and the end of 1987 were reviewed. Hepatitis B infection was the major predisposing condition. Six patients had taken significant doses of sex steroids. Seventeen of the patients were cirrhotic at the time of diagnosis and in seven of these there was a significant history of alcohol abuse. AFP was elevated in only 15 of the 34 patients. Multiple regression analysis revealed that the single, independent determinant of a raised AFP level was found to be presence of Hepatitis B infection. Resection was possible in 10 patients. In the last ten months, seven patients have been treated by embolisation of the tumour with Adriamycin bonded to lipidol. Survival was influenced by the presence or absence of cirrhosis but not by evidence of Hepatitis B infection. The prognosis for patients with hepatocellular carcinoma in Australia is as dismal as it is in any other country. Although a rare tumour its incidence may well increase as the community now contains relatively greater numbers of immigrants from areas where the risk of developing a hepatocellular carcinoma is higher and because of the number of drug addicts who are frequently exposed to Hepatitis B infection. With the exception of patients with Hepatitis B infection, screening with AFP holds little promise in the Caucasian community.