We reviewed 166 cases of renal cell carcinoma. The presenting symptoms varied from vague backache to hypovolemic shock. The most common symptoms were pain, hematuria, a palpable mass and hypertension. Most cases involved were clear cell carcinoma (83 per cent) and survival was no better than in cases of granular cell carcinoma. The tumors metastasized to almost every organ of the body. Bilateral simultaneous primary renal cell carcinoma is described in 1 patient, who has survived for more than 5 years. The over-all 5-year survival rates of simple and radical nephrectomy were 32 and 66.6 per cent, respectively. Radiation therapy does not improve survival irrespective of stage. The 5-year survival rate with renal vein involvement was 32 per cent. Nephrectomy in patients with distant metastasis did not alter survival. Among the patients with metastasis 74 per cent were dead before 1 year and 96 per cent before 3 years.