Background: Hepatocellular carcinoma (HCC) is a major cause of cancer-related mortality globally, with a strong association with chronic liver disease, particularly cirrhosis. In cirrhotic patients, the overlapping clinical manifestations of HCC and underlying liver dysfunction complicate timely diagnosis and management. Understanding the clinical characteristics of HCC in this population is essential for improving outcomes. Objective: To evaluate the clinical characteristics of HCC in cirrhotic patients, focusing on differences in liver function, demographic profiles, and etiological factors. Methodology: A cross-sectional observational study was conducted at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, between December 2019 and August 2020. The study included 66 participants divided into two groups: cirrhotic patients with HCC (n=33) and cirrhotic patients without HCC (n=33). Data were collected through clinical, biochemical, and radiological assessments, with HCC diagnosis confirmed via fine-needle aspiration. Statistical analysis included t-tests, Chi-square tests, and ROC analysis. Results: The mean age of HCC patients was 49.85 ± 14.40 years, with 87.9% male predominance, similar to the cirrhosis group (mean age: 46.15 ± 11.06 years, 72.7% male). Significant differences were observed in prothrombin time (p=0.002), INR (p<0.001), and serum albumin (p=0.009), indicating relatively preserved liver function in HCC patients. HCC patients predominantly fell into Child-Pugh class B (54.5%), whereas cirrhotic patients were more commonly class C (39.4%, p=0.037). Hepatitis B virus (HBV) was the leading etiological factor in both groups, with HBsAg detected in 84.8% of HCC and 93.9% of cirrhotic patients. Conclusion: HCC in cirrhotic patients presents with distinct clinical and biochemical profiles, including better-preserved liver function and higher serum albumin levels compared to cirrhotic patients without HCC. The high prevalence of HBV in the region underscores the need for targeted surveillance and early intervention strategies. Further multicenter studies are recommended to validate these findings and enhance diagnostic and therapeutic approaches.