Diagnosed With Advanced Renal Cell Carcinoma: Why You May Want a Second Opinion, and How to Find One

Many people with cancer can benefit from a second medical opinion. Those with advanced renal cell carcinoma (RCC), who are likely considering multiple treatment options, if not combinations of treatment options, can find it especially helpful to hear another oncologist’s thoughts.

“Renal cell carcinoma has so much variability in the ways it can be treated,” says Jacqueline T. Brown, MD, a medical oncologist with Emory Healthcare and an assistant professor at the Winship Cancer Institute at Emory University in Atlanta. “There are often multiple right answers depending on the individual patient’s situation.”

Here are a few reasons you may want to consider talking to a second provider.

Seeking out a second opinion can give you the confidence that you’re getting the best treatment available — something that can be especially important for people who have fewer resources for cancer care.

Some Groups Have Discrepancies in Care

There May Be More Than One Right Treatment

Since renal cell carcinoma can be treated in a variety of ways, it may be worth seeing if you prefer one doctor’s recommendations over another. “Different providers may have alternate approaches in treating the same disease,” says Farshid Sadeghi, MD, a urologic oncology surgeon and the chief of surgery at City of Hope Cancer Center in Phoenix, Arizona.

• Immunotherapy This includes monoclonal antibodies and immune checkpoint inhibitors such as pembrolizumab (Keytruda).
• Targeted Therapies Therapies like tyrosine kinase inhibitors (TKIs) are designed to target specific proteins that help cancer grow.
• Surgery These procedures remove the affected kidney.
• External Beam Radiotherapy This is a type of radiation treatment.
• Chemotherapy Medication given through an IV eliminates cancer cells.

There Are Newer Treatment Options Available

“The treatment landscape of ‌advanced RCC has dramatically changed in the past decade,” says Anthony Gulati, MD, a hematologist-oncologist with Stamford Health in Connecticut. While TKI medications have been the standard of care for renal cell carcinoma, the landscape has evolved with the development of newer TKI agents and also immunotherapies, says Dr. Gulati.

The nuance of which treatment combination to use in which scenario depends on your symptoms, cancer stage, and biomarkers — tiny biological clues found in blood or tissue tests, says Gulati.

There Are Advanced Surgical Techniques Available

It’s important to take into consideration how much experience a surgeon has with this procedure, as well as the reasons why they’re advocating for the surgery, says Sadeghi.

It’s never too late or too early to ask for a second opinion, but Dr. Brown says that two good times to do so are when you’re first diagnosed and when your provider recommends a switch in treatment.

• You don’t feel confident in your doctor’s diagnosis.
• Multiple treatments haven’t worked.
• You have an unusual type of renal carcinoma.
• Your provider is unwilling to try other options.
• You feel uncomfortable with your doctor or are unable to ask them questions.
• Your provider makes decisions about your treatment plan without consulting you.

“I also advise patients to just trust their gut,” says Brown. “If at any point in your treatment course you feel like you want a second opinion, then that’s the right time to get one.”

“As an oncologist,” says Brown, “I have confidence in the recommendations I make for patients, but if they are interested in a second opinion, it only helps me.” Sometimes patients return to her clinic even more confident in her treatment recommendation, or they find clinical trials somewhere else that fit them better.

• Ask your current doctor for their recommendation.
• Speak with a social worker.
• Join a renal cell carcinoma support group to get recommendations from others with this cancer.

Before your appointment, write down every question you can think of to ask the new doctor. Our experts recommend asking these questions at your second opinion visit:

• What do you think of my treatment up to this point and the future plan?
• Can you explain what treatment options are available to me?
• What is your experience with these options?
• How does my treatment plan compare to those recommended by national guidelines?
• If I need surgery, what can I expect before and after?
• What is your surgical experience?
• Do you know of any clinical trials that might be a good fit for me?
• Do these clinical trials require travel?

• What do you think of the other provider’s treatment plan?
• Which research studies or national guidelines do you follow to make recommendations?
• Why would you choose your own plan over the other?

• It may be a good idea to seek out a second opinion regarding advanced renal cell carcinoma treatment, especially if you lack access to some cancer care resources.
• There’s not necessarily a best treatment for advanced RCC — rather, multiple treatment options can be equally effective.
• If you want to seek out a second opinion, try asking your current provider for a referral. You can also ask a social worker, a support group peer, or your health insurer.
• If your second opinion matches your first, you can move forward with confidence; if they don’t match, you can ask both providers to meet and agree on a plan.