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Renal cell carcinoma continues to be a difficult malignancy to treat because of its ability to spread asymptomatically and its inherent resistance to conventional chemotherapy. However, molecular genetic studies bring new insights into the pathogenesis of this disorder and may provide new targets against which novel chemotherapeutic agents could be developed. Nephron-sparing surgery is also gaining wider acceptance as favorable long-term, cancer-free survival data emerge from clinical trials. For metastatic disease, cytokine therapy continues to be the mainstay of treatment despite marginal efficacy and a significant side-effect profile.