Background Hepatocellular carcinoma (HCC) is the most common primary liver cancer. Liver cancer is one of the commonest cancers worldwide in terms of incidence and mortality. Viral hepatitis, alcohol abuse, and autoimmune hepatitis are the common causes of HCC. Usually patients present at advanced stages where curative treatment is no longer possible. This study aims to analyze the demographic, clinical, and radiological profiles and treatment patterns of HCC patients. Methods We studied patients with HCC from March 2020 to August 2022 and analyzed their risk factors, clinical characteristics, and treatment modalities. Patients with at least one clinical, radiological, or biochemical evidence of HCC were considered for the study. Data were collected using predetermined proformas. Results Our study included 54 patients with a mean age of 57.17 years, and male: female ratio of 5:1. Of them, 68.52% consumed alcohol and 74.07% smoked cigarettes. At the time of diagnosis, 88.89% of them were symptomatic, weight loss (64.81%) being the most common symptom. The majority of the participants belonged to Barcelona Clinic Liver Cancer (BCLC) terminal stage (38.89%) and had more than three liver lesions (35.19%) involving the right lobe (55.56%). Only four patients underwent curative surgical resection. As most were in the terminal stage (BCLC D), supportive care was provided. Conclusion Alcohol-related liver cirrhosis is the most common cause of HCC in Nepal. Despite the significant progress in diagnostic methods, most of the patients are diagnosed at advanced and terminal stages. These patients are unsuitable for curative treatment and are treated with supportive methods. Keywords Autoimmune hepatitis, hepatitis, hepatocellular carcinoma, treatment.