Hepatocellular carcinoma (HCC) is the most common type of primary liver tumor. It is the second fastest growing cancer in incidence. The 5 year survival in Manitoba for those dignosed between 2011 and 2015 was 14%. This poor outcome was thought to be due to lack of treatment options. The aims of this study were to look at changes in survival after the Introduction of Transarterial Chemoembolization (T ACE) and to study the characteristics of three groups; those who received curative treatment, those who received noncurative treatment, and those who received supportive care. This was a retrospective study of patients diagnosed between 2011 and 2019 and Included 572 patients. There has been a significant improvement in survival from 2011 to 2019. The 5 year OS has increased from 14% to 21% between the 2011 to 2015 and the 2011 to 2019 cohorts . Patients with ascites, portal vein thrombosis or multiple focal disease are significantly more likely to .get supportive care only. Therefore, early identification and maintenance of liver function are paramount to providing curative and noncurative treatments . Cirrhosis and portal hypertension do not affect treatment options . Consequently, primary care providers should be aware that cirrhosis and portal hypertension do not exclude their patients from treatment In conclusion , our study indicates that adopting new proven treatments has a positive effect on survival of patients. Additionally, developing provincial guidelines that include clear criteria for use of local therapies ls likely to continue the trend of Improving survival.