Aging kidneys undergo significant structural changes, including a reduction in volume by 20–30% by age 80 and a decrease in weight to 180–200 g post-65. As the population ages, the incidence of renal cell carcinoma (RCC) in elderly patients is rising. RCC typically presents in the sixth decade of life, and its slower growing tumors often benefit from conservative management. However, larger masses may necessitate aggressive treatment. This chapter aims to illustrate the typical imaging findings and features of kidney cancer in elderly patients, highlighting the need for a patient-centered approach that considers the unique aspects of aging and associated health complexities.