The last two decades have seen ground-shifting advances in the epidemiology, genetics, diagnosis, and management of the renal cancer, particularly renal cell cancer. The most striking is that almost half are now diagnosed at an asymptomatic and earlier stage, and there have been parallel advances in the management of these early stage tumors. Nephron-sparing procedures are increasingly performed for these small tumors. Such procedures include radiologically guided ablative procedures, such as radiofrequency ablation and cryotherapy, as well as surgical options such as open or laparoscopic nephron-sparing surgery. More recently still, there have been encouraging advances in immunotherapy and the treatment of recurrent disease. There have also been sweeping advances in our understanding of the genetics of renal cancer.

However all these changes have also raised some contemporary dilemmas: for example, using imaging can we reliably resolve the nature of atypical renal masses; how to differentiate the indolent from the aggressive asymptomatic tumor; the recognition of residual or inadequately treated tumor post nephron-sparing procedures; and, finally, the follow-up of the accumulating cohort of patients treated by nephron-sparing procedures and those with familial or genetic renal cancer. These current predicaments are the focus of this issue of Contemporary Issues in Cancer Imaging. The authors are all recognized experts in their fields and I hope that this single volume should provide an up-to-date clinical and radiological summary of renal cell cancer for all those involved in the diagnosis and management of this challenging tumor.