Background: The understanding of its natural history may influence the prognosis and choice of treatment.Most of the published literatures were retrospective studies and moreover limited number of studies available for South Indian population.. Aim:The study was conducted with the objective to study the natural history of HCC in patients with cirrhotic background. Design:descriptive study Venue:he Department of Medical Gastroenterology and Hepatology, Stanley Medical Colleg Chennai..Study population: 201 consecutive patients with cirrhosis, Period: January2008 and January 2011, All patients were followed prospectively with every 6 months ultrasound examination of the liver, clinical and laboratory evaluation, Upper abdominal computed tomography (CT) was performed in all patients with focal lesions of the liver detectable and/or with increased levels of AFP (above 200 ng/ml) or peripheral portal thrombosis during follow–up. Results:Out of 201 patients only 49 (24%) patients developed HCC, in a mean period of 30.2±6 months and range of 22–40 months. . Mean age for male was 56.4±10.6 and 48.4 ± 11 for female.Co–infected patients had 60% risk of HCC compared to 20—25% risk in those with HBV or HCV alone. No significant difference in the overall risk of HCC was observed between HBV and HCV related cirrhosis, while the annual rate of HCC development showed an opposite trend in HCV related cirrhosis compared to HBV related disease. Among the symptoms abdominal pain (79.6.7%) and weight loss (34.7%) were most commonly observed symptoms. Conclusion:Hepatic decompensation was seen in half the patients at first presentation with Ascites in 52.8%, jaundice in 15.9% and hepatic encephalopathy in 3.8% of patients. The median serum AFP value of 786 ng/ml (range 0.4–92625) observed in the study population. Diagnostic value of AFP >200 ng/ml was present in 27 of 49 (55.1%) patients; with normal AFP in 9 (18.3%) patient.