A retrospective review of 110 cases of hepatocellular carcinoma (HCC) from the North East of England was undertaken to examine clinical features and prognosis in the 52 patients 65 years of age or more at presentation in comparison with 58 patients under 65. Symptoms and signs at the time of presentation were similar in the two age groups. Only 25% of patients were known to be cirrhotic at the time of presentation, but this increased to 75% after investigation. Although tumour stage at diagnosis was no worse in the elderly group, these patients received less intensive investigation and were significantly more likely to receive conservative therapy (p = 0.03). Although median survival was significantly worse in those aged > or = 65 years than in those < 65 years (10.5 and 18.5 weeks respectively; p = 0.02) this adverse effect disappeared when adjusted for the effects of treatment.