U Assessment

HISTORY. Question the patient about the classic triad of symptoms: hematuria, pain, and an abdominal mass. The most common single symptom is painless hematuria, whereas an abdominal mass is usually a late finding. The patient may also report vague signs and symptoms, such as a dull aching pain in the flank area. One-third of all patients diagnosed have these symptoms. One-third of patients have no symptoms at all, and the diagnosis is made during a routine physical examination. The other third of patients are diagnosed after the cancer has produced symptoms that are related to distant metastases.

PHYSICAL EXAMINATION. It is not unusual for the patient to have a normal physical examination. Occasionally, the patient appears weak, with an unintentional weight loss since the last examination. The patient may have hypertension, edema, or persistent fever unrelated to cold or flu. The placement of the kidneys, deep within the abdomen and protected by layers of fat, makes palpation of renal masses difficult. On occasion, palpation may reveal a smooth, firm abdominal mass.

PSYCHOSOCIAL. The patient may be preparing to retire or be retired when the diagnosis is made. Consider the patient's and significant others' ability to cope with a life-threatening illness at this life stage. The diagnosis may be met with anger. The patient diagnosed with late kidney cancer is facing a possibly terminal diagnosis. Assess support systems and consider making appropriate referrals if needed.

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