Renal cell carcinoma may present with which combination of signs?

• A. Hematuria and flank pain only
• B. Weight loss and anemia only
• C. Paraneoplastic syndromes only
• D. All of the above

Answer: (D)

Renal cell carcinoma can present with a mix of local urinary symptoms and systemic signs, including paraneoplastic phenomena. The tumor often causes hematuria and flank pain when it irritates or invades the kidney, and a classic but not always present triad includes a palpable mass, hematuria, and flank pain. At the same time, many patients experience systemic effects like weight loss and anemia from cancer-related cachexia and chronic blood loss, and paraneoplastic syndromes from tumor hormone production or cytokines—such as polycythemia from ectopic EPO, hypercalcemia from PTHrP, hypertension from renin, or Stauffer syndrome with hepatic dysfunction. Because RCC can show any combination of these local and systemic features, the most complete option—encompassing all of the above signs—is the best choice.