In renal cell carcinoma (RCC), a majority of the patients are today diagnosed incidentally due to the frequent use of cross-sectional imaging. This has resulted in the diagnosis of smaller tumours and less advanced tumour stages. Imaging for renal tumour diagnostics and staging aim to differentiate between benign and malignant disease and precise determination of primary tumour extent before decision on treatment strategy. Renal tumour biopsy serves to determine histology in a renal lesion using image-guided core biopsy to be used for treatment recommendation also in patients with metastatic disease. Treatment options are depending on not only tumour size, local tumour extent and complexity of the tumour but also patient’s comorbidity. Treatment options include surveillance, minimal invasive treatments as ablation and partial nephrectomy for nephron sparing treatment. For locally more advanced RCCs, radical nephrectomy should be considered. Surgery is performed with open technique, laparoscopically or robotic assisted, the latter becoming more frequently used.