BACKGROUND: Hepatocellular carcinoma (HCC) is associated with high mortality, ranking third among cancer deaths. This study aimed to spotlight the risk factors, treatment modality and clinical outcomes over a 5-year period in our hospital. METHODOLOGY: This retrospective study was done at the University College Hospital, Ibadan. All the patients with HCC diagnosed between 1st January 2019 and 31st December 2023 had their demographics, clinical information, and investigations collected. The outcome was overall survival, defined as time from diagnosis till death or lost to follow up. Data obtained was analyzed using SPSS version 20. RESULTS: A total of 138 patients were studied, 117 males (85%) and 21 females (15%). The median age was 46 years (IQR 14). Hepatitis B Virus infection was the main risk factor, found in 102 patients (73.9%). Among males, 35% took alcohol. Three patients (2.2%) with Barcelona Clinic Liver Cancer stage A, 2 underwent surgical resection, while the other one had palliative care. Of six (4.3%) stage B patients, two had levantinib, one of which also had TACE and four had palliative care only. Ten of the sixty-three patients with stage C (45.7%) received chemotherapy, while all 64 (46.4%) in stage D received supportive care. Two (1.4%) unclassified patients received symptomatic treatment. Median survival times were 1.2 months for palliative care, 3 months for chemotherapy, and 18 months for resection (P < 0.005). CONCLUSION: Hepatitis B Virus was the main risk factor for HCC in our environment. Hepatic resection offered the best opportunity for survival.