Renal cell carcinoma (RCC) accounts for approximately 90% of all primary malignant renal tumors and is estimated to account for approximately 28,000 new kidney cancer diagnoses and more than 11,000 deaths in the United States alone. symptoms are numerous and include the advanced triad of abdominal pain, masses, and hematuria. This triad is rarely seen and is a classic sign of advanced disease. Incidental finding of a renal mass by ultrasound and CT, now commonly used for cutaway imaging, has become the most common complaint at the time of presentation. When patients with RCC present with hematuria, intravenous urography is often the first diagnostic method employed. Intravenous urographic findings in suspected RCC include abnormalities in the renal profile affected by the mass and distortion and displacement of the collecting system. Renal tomography improves the clarity of the collecting system and renal parenchyma by excluding structures that are not in the desired imaging plane. Despite the fine detail of tomography, intravenous urography is inferior to other methods of assessing renal lesions, especially when examining small, anteriorly or posteriorly located masses that do not cause torsion of the renal profile or collecting system, and masses identified by intravenous urography or renal tomography require further confirmation by ultrasound or CT. The diagnosis of RCC is complicated by the high incidence of renal lesions. Most of these lesions are benign cysts. The ultrasound characteristics of a solid renal mass are a heterogeneous shape with indistinct margins, internal echogenicity and acoustic impedance of the mass. Unfortunately, ultrasound often fails to differentiate benign solid renal masses or complex cystic lesions from RCC, so these lesions detected by ultrasound require further CT. Despite the availability of multiple imaging modalities, RCC is sometimes difficult to diagnose preoperatively because of the wide variability in the presentation of benign and malignant lesions. However, CT remains the gold standard for the specific diagnosis of renal masses with or without enhancement, and the CT features of RCC are varied and include: solid masses that enhance, with speckled or irregular calcifications, thick or nodular walls with asymmetric borders, abundant hematopoiesis, hemorrhage and necrosis. CT images are important not only for the diagnosis but also for the staging of RCC. Overall, CT is between 60% and 90% accurate for staging and should include evaluation of renal veins, inferior vena cava-adrenal and local lymph nodes, and liver and lung for distant metastases.CT images of veins involved in RCC include filling defects or hypodense areas, changes in venous canal diameter, and enlarged veins.The prognosis for local lymph node metastases due to RCC is poor, with a 5-year survival rate of approximately 10%. Enlarged lymph nodes or multiple normal sized lymph nodes clustered together suggest lymph node metastasis. Lymph nodes larger than 2 cm in diameter often contain metastatic lesions. However, whether lymph nodes are involved based on size criteria is controversial because enlarged lymph nodes may also be due to reactive hyperplasia. Moreover, tiny metastatic deposits cannot yet be detected by the currently available imaging means. In conclusion, the sensitivity and specificity of determining the staging of retroperitoneal lymph node metastases by CT is greater than 80%. Improvements in MRI, such as the use of gadolinium elements and special techniques, have increased the value of MRI in the evaluation of renal lesions, especially smaller lesions. The presence of paramagnetic contrast enhancement with gadolinium is now used to differentiate benign from malignant lesions, much like enhanced CT. gadolinium is a major factor in the increased value of MRI. Furthermore, gadolinium has low nephrotoxicity, making it clinically important in patients with renal insufficiency or previous allergic reactions to iodine contrast agents. The indication for MRI as an adjunct to CT for accurate diagnosis and staging remains questionable in the prudent evaluation of renal masses. The advantages of MRI over CT include the ability to detect local tumor spread and venous involvement due to the ultra-clear tissue level of MRI, which is particularly suitable for the evaluation of the renal veins or inferior vena cava because of its clear superiority over ultrasound and CT and at least as sensitive as vena cava angiography in the examination of intravenous tumor emboli. . In conclusion, MRI staging is between 80% and 90% accurate and has a high specificity (97%) for diagnosing the involvement of the inferior vena cava. Arteriography plays only a limited role in the evaluation of RCC. Of all the tests available for the evaluation of renal masses, arteriography is the most expensive invasive test. It has now largely been replaced by other precise and noninvasive techniques such as ultrasound, CT and MRI. The typical findings of RCC on arteriography are: rich vascularity, arteriovenous traffic branches, and venous pools. Currently, the primary use of arteriography in patients with RCC is to obtain images of the vascular distribution prior to planned surgery to preserve the renal unit. Special indications include RCC in isolated kidneys, horseshoe kidneys, bilateral RCC, tumors in patients with von Hipple-Lindau syndrome, and tumor vascular infarction. Angiography may also be beneficial in the evaluation of renal masses combined with severe hypertension, vascular disease, or other medical history suggesting possible combined renal artery disease. Radical nephrectomy remains the gold standard for the treatment of clinically limited RCC. Renal unit-preserving surgery is widely accepted and the indications have been relaxed, but long-term outcomes are inconclusive. Similarly, the role of radical nephrectomy versus metastasectomy in patients with advanced disease, both before and after immunotherapy, remains controversial.