Adrenal Cancer

Adrenal cancer is a rare type of cancer that begins in one or both of your adrenal glands, which are small glands located on top of each kidney. These glands produce important hormones that regulate many body functions. The most common type is adrenocortical carcinoma (ACC), which can cause symptoms by producing too many hormones or by growing large enough to press on other organs.

What is Adrenal Cancer?

Adrenal cancer is a rare and serious disease where abnormal cells grow uncontrollably in your adrenal glands. These small glands sit above your kidneys and make hormones that control things like blood pressure, metabolism, and stress response. Adrenocortical carcinoma (ACC) is the most common form of adrenal cancer, and it can sometimes make too much of certain hormones, leading to various symptoms.

Your body has two adrenal glands, one above each kidney. These glands are vital for producing hormones, which are chemical messengers that help regulate many bodily functions. Hormones made by the adrenal glands include cortisol (a stress hormone), aldosterone (which helps control blood pressure), and sex hormones like androgens and estrogens. Adrenal cancer, specifically adrenocortical carcinoma (ACC), is quite rare. It can develop in the outer layer of the adrenal gland, called the adrenal cortex. This cancer can be aggressive, meaning it can grow quickly and spread to other parts of the body if not treated early. Sometimes, adrenal cancer cells continue to produce hormones, leading to an excess of these hormones in your body and causing noticeable symptoms.

Symptoms

Symptoms of adrenal cancer often appear when the tumor produces too many hormones or grows large enough to press on nearby organs. These symptoms can vary widely depending on which hormones are overproduced. Common signs include unexplained weight changes, new high blood pressure, or changes in body hair and appearance.

Many symptoms of adrenal cancer are related to an overproduction of hormones. For example, too much cortisol can lead to symptoms of Cushing's syndrome, such as weight gain (especially around the midsection and face), high blood pressure (hypertension), high blood sugar (diabetes), muscle weakness, easy bruising, and purple stretch marks on the skin. You might also experience mood changes, like anxiety or depression. An excess of aldosterone can cause high blood pressure and low potassium levels (hypokalemia), which may lead to muscle weakness, cramps, and an irregular heartbeat. If the tumor produces too many male hormones (androgens), women and children might notice increased facial and body hair, a deepening voice, or acne. If it produces too many female hormones (estrogens), men might experience breast enlargement (gynecomastia) or a decreased sex drive. Some symptoms are not related to hormone overproduction but rather to the tumor's size or spread. These can include a feeling of fullness or pain in the abdomen, a noticeable lump in the abdomen, unexplained weight loss, or back pain. These symptoms often appear as the cancer grows and presses on surrounding tissues or organs.

Causes & risk factors

The exact cause of most adrenal cancers is unknown. In many cases, the cancer develops without any clear reason. However, a small number of adrenal cancers are linked to rare inherited genetic conditions. These conditions increase a person's risk of developing various cancers, including adrenal cancer.

For the majority of people diagnosed with adrenal cancer, there is no clear cause. Scientists do not fully understand why these cells begin to grow out of control in the adrenal glands. It is not linked to lifestyle factors like diet or smoking in the way some other cancers are. However, a small percentage of adrenal cancers are associated with certain rare genetic syndromes that are passed down through families. These include Multiple Endocrine Neoplasia Type 1 (MEN1), Li-Fraumeni syndrome, Beckwith-Wiedemann syndrome, and Carney complex. If you have a family history of these conditions, your doctor might recommend genetic counseling or screening. It is important to remember that even with these genetic links, adrenal cancer remains very rare. Having one of these syndromes does not guarantee you will develop adrenal cancer, but it does increase your risk compared to the general population.

How it's diagnosed

Diagnosing adrenal cancer typically involves a combination of tests to check hormone levels and locate any tumors. Your doctor will start with a physical exam and review your medical history. Blood and urine tests are used to measure hormone levels, while imaging scans help identify the tumor's size and location.

If your doctor suspects adrenal cancer, they will likely order several tests. Blood and urine tests are crucial for measuring the levels of various hormones produced by your adrenal glands. High levels of certain hormones can indicate the presence of an adrenal tumor, and these tests help determine if the tumor is actively producing hormones. Imaging tests are also a key part of the diagnostic process. These can include computed tomography (CT) scans, magnetic resonance imaging (MRI), and positron emission tomography (PET) scans. These scans create detailed pictures of your adrenal glands and surrounding areas, helping doctors locate the tumor, assess its size, and check if it has spread to other parts of your body. In some cases, a biopsy (taking a small tissue sample for examination) might be considered. However, doctors often try to avoid a biopsy before surgery for adrenal tumors because there is a small risk of spreading cancer cells. Instead, the diagnosis is often confirmed after the tumor is surgically removed and examined by a pathologist.

Treatment options

Treatment for adrenal cancer depends on the cancer's stage, size, and whether it has spread. Surgery is the primary treatment, especially if the cancer is caught early and has not spread. Other treatments, such as chemotherapy, radiation therapy, or targeted therapy, may be used in combination with surgery or for more advanced cases.

For adrenal cancer that has not spread beyond the adrenal gland, surgery (called an adrenalectomy) is the main treatment. The goal of surgery is to remove the entire tumor and the affected adrenal gland. If the cancer has spread to nearby tissues or organs, surgeons may try to remove as much of the cancer as possible. After surgery, or for more advanced cancers, other treatments may be used. Chemotherapy uses powerful drugs to kill cancer cells throughout the body. Mitotane is a specific chemotherapy drug often used for adrenal cancer, as it can help reduce hormone production and slow cancer growth. Radiation therapy uses high-energy beams to destroy cancer cells or relieve symptoms like pain. Targeted therapy is a newer approach that uses drugs designed to attack specific weaknesses in cancer cells. These treatments are often more precise than traditional chemotherapy and may have fewer side effects. Your treatment plan will be tailored to your specific situation, and your healthcare team will discuss the best options with you.

Recovery & outlook

The recovery and outlook for adrenal cancer vary greatly depending on how early the cancer is found and how much it has spread. Early detection and complete surgical removal offer the best chance for a good outcome. However, adrenal cancer can be aggressive, and even after successful treatment, regular follow-up care is crucial to monitor for any recurrence.

Recovery from adrenal cancer treatment involves careful monitoring and follow-up. After surgery, you will need time to heal, and your medical team will monitor your hormone levels and overall health. If one adrenal gland is removed, the remaining gland can often produce enough hormones. If both are removed, or if the remaining gland doesn't produce enough, you will need lifelong hormone replacement therapy. The outlook for adrenal cancer is highly individual. Cancers that are small and confined to the adrenal gland when diagnosed have a better prognosis than those that have spread. Unfortunately, adrenal cancer can be aggressive and has a tendency to recur (come back) even after successful treatment. This is why regular follow-up appointments, including imaging scans and blood tests, are very important. Living with adrenal cancer or its aftermath can be challenging. Support groups, counseling, and open communication with your healthcare team can help you manage the physical and emotional aspects of recovery. Your doctor will provide personalized information about your specific prognosis and what to expect.

When to see a doctor

You should see a doctor if you experience persistent or unexplained symptoms that could indicate adrenal cancer. These include new or worsening high blood pressure, unexplained weight changes, a noticeable lump in your abdomen, or sudden changes in body hair or breast size. Early detection is important for effective treatment.

It is important to pay attention to your body and seek medical advice for any new or concerning symptoms. If you notice a feeling of fullness or pain in your abdomen that doesn't go away, or if you feel a lump in your abdominal area, you should contact your doctor. Unexplained weight loss or significant weight gain, especially around your midsection, also warrants a medical evaluation. Other red-flag symptoms include new or difficult-to-control high blood pressure, muscle weakness, or changes in your appearance such as increased facial hair in women, a deepening voice, or breast enlargement in men. While these symptoms can be caused by many less serious conditions, it is always best to have them checked by a healthcare professional. Do not delay seeking medical attention if you experience any of these signs, especially if they appear suddenly or worsen quickly.

Frequently asked questions

Is adrenal cancer common?

No, adrenal cancer is very rare. It affects only about 1 to 2 people per million each year. Because it is so uncommon, many doctors may not see a case of adrenal cancer often in their practice.

Can adrenal cancer be cured?

Adrenal cancer can be cured, especially if it is found early and completely removed with surgery. The chances of a cure are highest when the cancer is small and has not spread beyond the adrenal gland. For more advanced cases, treatment focuses on controlling the disease and managing symptoms.

What is the difference between an adrenal tumor and adrenal cancer?

An adrenal tumor is any abnormal growth on the adrenal gland. It can be either benign (non-cancerous) or malignant (cancerous). Adrenal cancer specifically refers to a malignant tumor that can grow and spread to other parts of the body. Many adrenal tumors are benign and do not require treatment.

What happens if an adrenal gland is removed due to cancer?

If one adrenal gland is removed, the remaining adrenal gland can usually take over and produce enough hormones for your body's needs. If both adrenal glands are removed, or if the remaining gland doesn't function well, you will need to take hormone replacement medications for the rest of your life to replace the hormones your body can no longer make.

Does adrenal cancer spread quickly?

Adrenal cancer, particularly adrenocortical carcinoma (ACC), can be aggressive. This means it has the potential to grow quickly and spread to nearby organs or distant parts of the body, such as the lungs or liver. The speed of spread varies among individuals and depends on the specific characteristics of the tumor.

Are there different types of adrenal cancer?

The most common type of adrenal cancer is adrenocortical carcinoma (ACC), which starts in the outer layer of the adrenal gland (cortex). Other types of cancer can occur in the adrenal glands, such as pheochromocytoma (which usually starts in the inner part, the medulla, and is often benign) or neuroblastoma (a childhood cancer), but ACC is what is typically referred to as "adrenal cancer" in adults.

Sources

• MedlinePlus — Adrenal Cancer
• Mayo Clinic — Adrenal Cancer
• Cochrane Library — Adrenal Cancer