The evaluation and management of 3 patients with renal cell carcinoma and varying degrees of vena caval involvement are described. Extrinsic compression, intraluminal tumor thrombus and direct invasion have characteristic features on the inferior venacavograms. With knowledge of the nature and extent of vena caval disease total removal of the tumor is possible in most cases with an acceptably low morbidity. Extensive vena caval pathology by no means precludes long-term survival and should not be regarded as a sign of inoperability.