HCV-related HCC is the fifth most common cancer worldwide, accounting for 85%-90% of primary liver cancers. Advanced stage liver fibrosis (stage F3) carries an increased risk of HCC, and patients with cirrhosis (stage F4) have an annual HCC incidence of approximately 4%. HCV causes HCC mainly through continuous inflammation and hepatocyte regeneration in the setting of chronic hepatitis and subsequent progression to cirrhosis, which is thought to lead to chromosomal damage and possibly to initiate hepatic carcinogenesis. With the advent of direct-acting antiviral agents (DAAs) therapy, over 95% of the treated patients were able to achieve sustained virologic response (SVR) or HCV cure. HCV cure reduces the HCC risk but those with preexisting cirrhosis remain at risk. Over the past years, the early diagnosis of HCC has relied on surveillance with ultrasonography (US) as recommended by all guidelines with or without serological assessments of alpha-fetoprotein (AFP).