Background: Hepato-cellular carcinoma (HCC) is considered to be one of the most common malignancies worldwide. In Egypt a high incidence rate of HCC has been reported with a strong association between chronic HCV infection, cirrhosis and HCC. Therapeutic strategies in HCC should concentrate on early detection and screening in individuals at risk. There are multiple strategies in the treatment of HCC including: transplantation, resection, ablation, and embolization. Objective: This study aimed to use combined trans-arterial chemoembolization (TACE) and microwave ablation (MWA) in the management of large HCC for better outcome. Patients and Methods: In our study, we used TACE combined with MWA for group of patients having single large HCC more than 5 cm. TACE was done first followed by MWA after one month then doing Triphasic CT to evaluate the effect of treatment and assessment of the response according to mRECIST criteria. Results: TACE combined with MWA had good effect in managing large HCC and reduced recurrence rate and thus reduced the need for multiple sessions of TACE. Conclusion: Combined TACE/MWA technique is a simple, effective, and less expensive with a low morbidity rate compared to surgical or other combined treatments.