Background and Aim: The burden of hepatocellular carcinoma (HCC) has been increasing in Egypt. This fact raises the question, does the high prevalence of HCC in Egypt is related only to HCV? or is it augmented by AFB1 exposure in our patients? The aim of this study was to identify the role of aflatoxin as an environmental risk factor attributable to liver cancer in Nile delta in Egypt. Patients and Methods: This cross sectional study was carried out in tropical medicine department in Tanta university hospital on 160 patients with HCC, 80 cirrhotic patients. Sixty individuals were invited to share in the study as a control group. All patients and control were evaluated for age, sex, residence, occupation, viral markers, liver functions and serum level of aflatoxinB1. Results: Aflatoxin level in serum was significantly higher in HCC patients when compared to cirrhotics and to controls. The mean age of HCC patients was 58.575 ± 9.583 years. HCC was much higher in males than females with male to female ratio 4.7:1. Concerning smoking, 45% of HCC patients were smokers. DM was diagnosed in 42.5% of HCC cases. Anti HCV-Ab was present in 95% of HCC cases. Conclusions: Environmental aflatoxin seems to be a major risk factor for HCC in Nile delta. The high prevalence of HCC in Nile delta in Egypt is related to HCV and it is augmented by AFB1 exposure.