Q: What are the pain referral patterns in patients with renal cell carcinoma?
—Carlton J. Lewis, DO, Lufkin, Tex.

A: Patients with renal cell carcinoma are generally asymptomatic until their tumors are large and/or metastatic. They then may present with a variety of symptoms related to hematuria, mass disease in the abdomen and flank, or sites of metastasis, including bones, lung, lymph nodes, and liver. Renal carcinoma patients may also present with a number of paraneoplastic syndromes. In addition to flank pain from the tumor mass, pain from metastatic involvement of bone may be present anywhere in the skeleton. Pain may also occur from paraneoplastic polymyalgia, presenting as diffuse muscular pain. Patients may also have cough from lung involvement; fever; cachexia; hormone production, including erythropoietin leading to erythrocytosis; and hypercalcemia.
—Gwen L. Nichols, MD (98-3)

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