A 45-year-old male presents to his primary care provider with a 2-month history of persistent flank pain, hematuria, and unintentional weight loss. He reports the pain as dull and intermittent, located on the right side of his abdomen, and has been getting progressively worse. He also mentions feeling fatigued and noticing a decrease in appetite over the past few weeks. The patient has no significant past medical history but has a family history of cancer, with his father having had prostate cancer.

On physical examination, the patient appears mildly cachectic but is otherwise in no acute distress. There is mild tenderness over the right flank, but no palpable masses are noted on abdominal examination. There are no signs of lymphadenopathy, hepatomegaly, or splenomegaly. No tenderness or abnormal findings are noted during a rectal examination.

Routine blood tests show mild anemia and elevated creatinine levels, while urinalysis reveals microscopic hematuria. To further evaluate the suspected renal pathology, an abdominal ultrasound is ordered, revealing a solid mass in the right kidney. A subsequent CT scan with contrast demonstrates a large, heterogeneous mass with central necrosis in the right kidney, suggestive of renal cell carcinoma (RCC). Chest imaging is performed to rule out metastasis, and no distant spread is noted.

After a discussion with the urology team, the patient is scheduled for a nephrectomy to remove the tumor. Further staging workup will be done after surgery to assess for possible metastasis, and the patient will undergo adjuvant therapy based on the final pathology results.