Renal cell carcinoma is a frequent disease. Recently, its incidence has been rising. Kidney tumors are detected more frequently by the newer radiologic techniques, but the diagnosis is steel difficult and occurs often late in the natural history of the disease. A high proportion of patients have metastases at diagnosis or after initial surgery. Many types of systemic therapy have been studied but resistance to radiotherapy and chemotherapy is the rule. There is a potential role for immunomodulation in the inhibition of tumor growth but clinical issue remain uncertain. In this review we discuss recent developments in epidemiology, histologic classification, tumor biology, methods of diagnosis, surgical techniques and immunotherapy for patients with metastatic disease.