Renal cell cancer (RCC) mostly arises from the proximal renal tubules and is classified as an adenocarcinoma. The most reliable treatment for RCC is surgical excision; chemotherapy or radiotherapy does not have a practical effect on RCC. In selected patients, immunotherapy, including cytokine administration, has survival benefits. There is no established definition of early RCC. Surgical removal of organ-confined disease (T1 and T2) is likely to achieve tumor-free status leading to good prognosis. Possible definitions, diagnosis and treatment options for T1 and T2 disease are discussed.