OBJECTIVE: To describe the epidemiology, clinical features, management and outcomes of hepatocellular carcinoma (HCC) in the Northern Territory over the past decade. DESIGN, SETTING AND PATIENTS: An NT-wide epidemiology study covering the period 1991-2010 and a clinical cohort study including patients diagnosed during 2000-2011. HCC diagnoses were provided by the NT Cancer Registry and cross-checked against clinical records. MAIN OUTCOME MEASURES: Age-adjusted incidence of HCC; management; clinical features; and median and 1-year survival. RESULTS: There were 145 incident cases of HCC in the NT during 1991-2010, giving an age-adjusted annual incidence of 22.7/100 000 (95 CI, 17.2-26.8) for Indigenous Australians and 4.0/100 000 (95 CI, 2.1-5.8) for non-Indigenous Australians - an incidence rate ratio of 5.9 (95 CI, 4.7-7.4). There was no significant change in annual age-adjusted incidence over this period. The most common causative factors were hepatitis B virus in Indigenous people and hepatitis C virus in non-Indigenous people. Most people were diagnosed late, only 13/80 were diagnosed by screening, and outcomes were poor, with 28/80 overall surviving to 1 year. Outcomes were better among those managed through a centralised multidisciplinary service than among those who were not (adjusted hazard ratio for death at 1 year, 0.35 [95 CI, 0.16-0.81]). CONCLUSION: HCC incidence remains high in the Indigenous people of the NT. More resources are needed for HCC surveillance and management programs in this population.