The understanding of the biology and the treatment of renal cell carcinoma has changed considerably over the years. Clear cell carcinomas remain the predominant subtype, and non-clear cell histology has a wide range of presentation and prognosis. Surgery remains a cornerstone of management—so much so that a significant number of patients with metastatic disease may also benefit from it. There is still some debate regarding adjuvant therapy; evidence suggests that immunotherapy provides an OS benefit, but the question remains to be settled convincingly. Management of advanced disease has settled into a predictable pattern; erstwhile standards of interferon and interleukins are no longer practiced while the VEGF TKIs have taken on a supporting role. Immune checkpoint inhibitors are the present-day cornerstone of systemic therapy, typically in combination with a VEGF TKI or a CTLA4 inhibitor. The following discussion delves into these aspects and more.