In a patient with renal cell carcinoma, which symptom is most commonly reported?

In patients with renal cell carcinoma, the symptom that is most commonly reported is painless hematuria. This refers to the presence of blood in the urine without any accompanying pain, and it often serves as a critical sign that prompts medical evaluation. Renal cell carcinoma can cause irritation and damage to the urinary tract, leading to bleeding.

Painless hematuria is particularly significant because it may occur early in the course of the disease, making it one of the hallmark symptoms that can lead to earlier diagnosis. Other symptoms like fatigue, weight loss, and flank pain may also be present but are generally more nonspecific and can occur later in the disease or be attributed to other conditions. Flank pain, in particular, while relevant, usually indicates progression or invasion of surrounding structures, making it less common initially compared to the presentation of painless hematuria.

Overall, while fatigue, weight loss, and flank pain do occur in patients with renal cell carcinoma, painless hematuria stands out as the defining symptom that often brings patients to medical attention.