Renal cell carcinoma most commonly presents with which symptom or sign?

• A. Hypocalcemia
• B. Inguinal pain
• C. Anemia
• D. Hematuria

Answer: (D)

Hematuria is the most common presenting feature of renal cell carcinoma because the tumor frequently involves or irritates the renal parenchyma and collecting system, leading to blood in the urine. While flank pain or a palpable mass can occur, they are less common than hematuria, and the classic triad is not always present. Anemia can occur from chronic disease or bleeding but is not the most typical initial sign. Hypocalcemia and inguinal pain don’t fit with RCC presentation; hypercalcemia from paraneoplastic processes is more characteristic than low calcium. So blood in the urine best matches how RCC most commonly presents.