Background: Hepatocellular carcinoma (HCC) is the commonest primary cancer of the liver. Incidence is increasing and HCC has risen to become the 5th commonest malignancy worldwide and the third leading cause of cancer related death, Microwave ablation (MWA), a thermal ablative technique that has recently emerged as a new therapeutic option. The aim of this study was to evaluate the use of microwave ablation in hepatocellular carcinoma treatment and to assess the outcome. Methods: This study was carried out on 52 patients proved to have HCC who presented to Radiology Department in Alexandria University Hospitals. Microwave ablation was performed percutaneously under real-time ultrasound guidance Results: All patients completed the procedure safely. Conclusion: Thermal ablation, including radiofrequency ablation (RFA) and microwave ablation (MWA), have been shown to be effective for treating HCC. Microwave ablation is a safe, effective and promising technique and a good replacement to surgical interference for patients who are not amenable to surgical therapy.