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Management of Bilateral and Multifocal RCC: Family Matters

Danielle Bucco
Published: Friday, Jul 07, 2017

Gennaday Bratslavsky, MD

Gennaday Bratslavsky, MD

Managing bilateral and multifocal renal cell carcinoma (RCC) is as much a matter of family history as deciding which patients need a biopsy and which tumor to start treating first, according to Gennaday Bratslavsky, MD. Bratslavsky directed a course exploring the treatment of this complex condition at the 2017 American Urological Association meeting.

“The genetic profile of kidney cancer is now becoming much more prevalent in identification of therapeutic targets,” he said. “As we move forward to precision medicine, there are numerous tests, profiles, categories, and strategies that we're all working on to be able to pinpoint a better treatment for the right patient.”

In an interview with OncLive, Bratslavsky, professor and chair of urology, chief of urologic oncology, and division chief of urologic male health, SUNY Upstate Medical University, discussed the evaluation and management of RCC and highlighted genetic testing for the patient’s family.

OncLive: Can you give an overview of your presentation?

Bratslavsky: We have a course this year on the evaluation and management of bilateral multifocal and hereditary RCC. This has many implications because quite a few patients that we see in a urologist’s office do present with more than one tumor. When a patient has more than one tumor, it raises the question of what side to start with, who to biopsy, and who to test.

To answer those questions, you start by doing a comprehensive history and physical. A huge importance in evaluating these patients is recognition of a family history or certain potential signs of syndromes that could be associated.

Not every patient who presents with tumors on each side of the kidney will have a genetic disorder. As we’re learning more about the genetics of patients with kidney cancer, we’re sometimes able to trace it down to some history in the family, for example, a family member who had the removal of the uterus at a young age. That can guide us into appropriate testing.

Sometimes you need to start with a biopsy since having knowledge of the specific histology from the biopsy can direct you further into additional genetic testing. Additionally, the surgical incision may direct your next step of management once you have more than one tumor. All of this is individualized, but there are several specific algorithms that we have developed that will hopefully help practitioners, urologists, and those who run into these complex issues identify the best next steps.

Why is it important for a patient to understand his or her family history?

Having a family history of kidney cancer would qualify patients for what is known as hereditary kidney cancer. Kidney cancer is still quite prevalent. There will be over 60,000 new cases of kidney cancer diagnosed in the United States this year. For this reason, to say that anyone who had a family member with kidney cancer does not necessarily qualify these patients for tests. Nevertheless, it is something to keep in mind.

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