The management of renal cell carcinoma (RCC) is evolving owing to the increasing detection of small renal masses, greater understanding of the metabolic pathways involved, new targeted medical treatments for metastatic RCC, and evolving surgical and minimally invasive image-guided treatment techniques. Consequently, the role of imaging and radiology has expanded, with new challenges encompassing all aspects of management, including diagnosis, predicting cell type, staging, preoperative vascular mapping, image-guided treatment and biopsy, detection of recurrence and the use of imaging as a biomarker to assess response to treatment. This article is a comprehensive review of RCC, outlining the etiology of the disease, RCC histological subtypes and their imaging characteristics, imaging modality techniques for evaluation of RCC, treatment strategies and the management of small renal masses.