65yrs old male complains of lump on . side lower back associated with blood in urine, wt. loss and night sweats. On investigation it was diagnosed to be RCC 8cm involving abdominal lymph nodes but no distant metastasis. What should be most appropriate management of this patient?

**Core Concept**
The case presents a 65-year-old male with symptoms suggestive of a renal malignancy, specifically **renal cell carcinoma (RCC)**, which is a type of cancer that originates in the lining of the proximal convoluted tubule, a part of the small tubes in the kidney that transport waste molecules from the blood to the urine.

**Why the Correct Answer is Right**
Given the diagnosis of **RCC** with involvement of abdominal lymph nodes but no distant metastasis, the most appropriate management would typically involve a multimodal approach, including **surgical resection** of the primary tumor and affected lymph nodes, as this offers the best chance of cure for localized disease.

**Why Each Wrong Option is Incorrect**
**Option A:** Without knowing the specifics, generally, options that do not include surgical intervention for localized **RCC** are less likely to be correct.
**Option B:** Similarly, options lacking comprehensive management may not be ideal.
**Option D:** Any option that does not prioritize surgical removal for a patient with resectable disease is likely incorrect.

**Clinical Pearl / High-Yield Fact**
In patients with **RCC**, the presence of symptoms such as hematuria, weight loss, and night sweats, known as the classic triad, suggests advanced disease, but surgical resection can still offer a cure if the disease is localized.

**Correct Answer:** D. Surgical resection of the tumor and involved lymph nodes.

✓ Correct Answer: D. Radical nephrectomy