Adrenal Cancer Treatment Options

Adrenal cancer treatment options aim to remove or control cancerous growths in your adrenal glands, which are small glands above your kidneys. Treatment plans are highly personalized, depending on the cancer's stage, size, and whether it produces hormones. Surgery is often the primary approach, sometimes followed by medication or radiation therapy to improve outcomes.

What is Adrenal Cancer Treatment Options?

Adrenal cancer treatment options focus on managing or eliminating malignant (cancerous) tumors that form in your adrenal glands. These small glands sit atop your kidneys and produce vital hormones. Treatment strategies vary significantly, tailored to the specific type and stage of adrenal cancer, whether it's making excess hormones, and your overall health.

Adrenal cancer is a rare disease where abnormal cells grow in the adrenal glands. When these growths are cancerous, they are called malignant tumors. The most common type of malignant adrenal cancer is adrenocortical carcinoma (ACC). Treating adrenal cancer often involves a team of specialists, including surgeons, oncologists (cancer doctors), and endocrinologists (hormone specialists). The main goal of treatment is usually to remove the cancer entirely if possible. If the cancer has spread, treatments aim to slow its growth and manage symptoms. Because adrenal cancer can sometimes produce too many hormones, treatment plans also address these hormonal imbalances. Managing excess hormones is crucial for your health and well-being. Your doctor will discuss the best approach for your specific situation.

Symptoms

Symptoms of adrenal cancer often arise from the tumor producing excess hormones or from the tumor growing large enough to press on nearby organs. These signs can include unexplained weight changes, high blood pressure (hypertension), muscle weakness, or a noticeable lump in your abdomen. Recognizing these symptoms early is important for timely diagnosis.

Adrenal cancer symptoms can vary widely. Many symptoms are caused by the adrenal tumor making too many hormones. For example, if the tumor produces too much cortisol, you might experience weight gain, especially around your midsection and face, high blood sugar (diabetes), or easy bruising. Women might also notice increased facial hair (hirsutism) or irregular periods. Excess production of aldosterone can lead to high blood pressure and low potassium levels (hypokalemia), which may cause muscle weakness and cramps. If the tumor makes too many androgens or estrogens, children might experience early puberty, while women could develop a deeper voice or facial hair, and men might have breast enlargement (gynecomastia). Some symptoms are not related to hormones but occur because the tumor is growing. As the tumor gets larger, it can cause pain in your abdomen or back, a feeling of fullness, or a noticeable lump. Unexplained weight loss can also be a sign. It is important to remember that these symptoms can also be caused by many other less serious conditions.

Causes & risk factors

The exact cause of adrenal cancer is often unknown, and most cases happen by chance without a clear reason. However, certain rare inherited genetic conditions can increase your risk. These genetic syndromes are specific changes in your genes that make you more likely to develop this type of cancer.

Most cases of adrenal cancer, particularly adrenocortical carcinoma (ACC), are considered sporadic. This means they develop without any known genetic predisposition or clear environmental cause. Researchers continue to study why these cancers form. While rare, some genetic syndromes are linked to an increased risk of developing adrenal cancer. These include Li-Fraumeni syndrome, Beckwith-Wiedemann syndrome, Multiple Endocrine Neoplasia type 1 (MEN1), and Familial Adenomatous Polyposis (FAP). If you have a family history of these conditions, your doctor might recommend genetic counseling. It is important to note that having a risk factor does not mean you will definitely get adrenal cancer. Conversely, many people who develop adrenal cancer do not have any known risk factors. There are currently no strong environmental risk factors identified for this type of cancer.

How it's diagnosed

Diagnosing adrenal cancer typically involves a combination of tests to identify the tumor and determine its characteristics. Doctors usually start with blood and urine tests to check hormone levels, followed by imaging scans like CT or MRI to locate the tumor and see if it has spread. A biopsy is rarely done before surgery due to potential risks.

When adrenal cancer is suspected, your doctor will likely begin with a physical exam. They will look for signs of hormone excess, such as changes in your body shape or skin, and feel your abdomen for any lumps. Blood and urine tests are crucial for diagnosis. These tests measure the levels of various hormones produced by the adrenal glands, such as cortisol, aldosterone, androgens, and estrogens. High or abnormal levels can indicate an adrenal tumor that is overproducing hormones. Imaging tests help doctors visualize the adrenal glands and any tumors. Common imaging methods include computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, and sometimes positron emission tomography (PET) scans. These scans can show the size and location of the tumor and help determine if the cancer has spread to other parts of your body (metastasis). In most cases, a definitive diagnosis of adrenal cancer is made after the tumor is surgically removed and examined under a microscope. A biopsy before surgery is generally avoided because it carries a small risk of spreading cancer cells.

Treatment options

Treatment for adrenal cancer is highly individualized and depends on several factors, including the cancer's stage, size, and whether it produces hormones. Surgery to remove the tumor is the primary treatment for localized cancer. Other options may include medication, such as mitotane, or radiation therapy, especially for advanced or recurrent disease.

**Surgery (Adrenalectomy):** This is the main treatment for adrenal cancer, especially when the cancer is confined to the adrenal gland. The goal is to remove the entire tumor and any surrounding affected tissue. This complete removal, known as an R0 resection, offers the best chance for a cure. Surgery can be performed as an open procedure, which involves a larger incision, or sometimes minimally invasively (laparoscopic surgery) for smaller, less aggressive tumors. If the cancer has spread, surgery might still be performed to remove as much of the tumor as possible (debulking surgery) to help reduce symptoms. **Medication:** After surgery, or for cancer that has spread or recurred, medication may be used. Mitotane is a common drug specifically approved for adrenocortical carcinoma. It works by destroying adrenal cancer cells and can also reduce hormone production. Mitotane often has significant side effects, such as nausea, vomiting, and fatigue, and requires careful monitoring by your doctor. Other chemotherapy drugs, such as etoposide, doxorubicin, and cisplatin (sometimes used together as the EDP regimen), may be considered for advanced or metastatic adrenal cancer. Hormone-blocking medications, like ketoconazole or metyrapone, can also be used to control symptoms caused by excess hormone production. **Radiation Therapy:** This treatment uses high-energy beams to kill cancer cells or shrink tumors. Radiation therapy is not typically used as the primary treatment for the adrenal tumor itself. Instead, it is often used to relieve pain or other symptoms caused by cancer that has spread to other areas, such as bones. It may also be considered after surgery in some cases if there is a high risk of the cancer returning. **Clinical Trials:** For some people, participating in a clinical trial may offer access to new and experimental treatments. Your doctor can discuss if a clinical trial is a suitable option for your specific situation.

Recovery & outlook

The recovery and outlook for adrenal cancer vary greatly, depending on factors like the cancer's stage at diagnosis, tumor size, and how completely it was removed. Adrenal cancer has a notable risk of returning, even after successful treatment. Regular follow-up care, including imaging and blood tests, is crucial to monitor for any recurrence and manage long-term health.

The prognosis, or outlook, for adrenal cancer is highly individual. It depends significantly on whether the cancer was caught early and could be completely removed with surgery. Cancers that are smaller and have not spread (localized) generally have a better outlook than those that have spread to other parts of the body (metastatic). Even after successful surgery, adrenal cancer has a relatively high chance of coming back (recurrence). This is why ongoing monitoring is a critical part of recovery. Your medical team will schedule regular follow-up appointments, which will likely include imaging scans like CT or MRI and blood tests to check for any signs of the cancer returning or changes in hormone levels. Living with adrenal cancer or after its treatment can involve managing side effects from therapies and, in some cases, requiring hormone replacement therapy if both adrenal glands were removed. Supportive care, including pain management and psychological support, is also an important part of recovery. Your healthcare team will work with you to create a comprehensive follow-up plan tailored to your needs.

When to see a doctor

You should see a doctor if you experience new or worsening symptoms that could suggest adrenal cancer, especially if they develop quickly. These include unexplained weight changes, new high blood pressure, persistent muscle weakness, unusual hair growth, or a noticeable lump or pain in your abdomen. Early evaluation of these signs is important.

It is important to consult your doctor if you notice any persistent or concerning changes in your body. While many symptoms can be caused by less serious conditions, it is always best to have them checked. Pay particular attention to symptoms that appear suddenly or worsen over time. Specific red-flag symptoms that warrant a doctor's visit include unexplained weight gain or loss, new onset or worsening high blood pressure, muscle weakness that doesn't go away, or a feeling of fullness or a lump in your abdomen. For women, new or increased facial hair or irregular periods should also be discussed with a healthcare provider. If you have a family history of genetic syndromes linked to adrenal cancer, such as Li-Fraumeni syndrome, discuss this with your doctor. They may recommend regular screenings or genetic counseling. Remember, your doctor is the best person to evaluate your symptoms and provide an accurate diagnosis and appropriate guidance.

Frequently asked questions

Can adrenal cancer be completely cured?

A complete cure for adrenal cancer is most likely when the cancer is found early and can be entirely removed through surgery. However, even after successful surgery, there is a significant risk of the cancer returning. Regular follow-up care is essential to monitor for any recurrence.

What is mitotane, and how does it work for adrenal cancer?

Mitotane is a medication specifically used to treat adrenocortical carcinoma, a type of adrenal cancer. It works by directly destroying adrenal cancer cells and can also help reduce the production of excess hormones by the adrenal glands. It is often used after surgery or for advanced cancer.

Are there any dietary changes that can help treat adrenal cancer?

While a healthy, balanced diet is always recommended for overall well-being, there is no specific diet proven to treat adrenal cancer directly. However, managing symptoms like high blood pressure or diabetes, which can be caused by hormone-producing tumors, may involve dietary adjustments. Always discuss diet with your healthcare team.

How often will I need follow-up appointments after adrenal cancer treatment?

The frequency of follow-up appointments after adrenal cancer treatment varies but is typically regular and ongoing. Your doctor will likely recommend frequent visits, including imaging scans (like CT or MRI) and blood tests, especially in the first few years, to monitor for any signs of recurrence or new issues.

What are the common side effects of adrenal cancer treatment?

Side effects depend on the specific treatment. Surgery carries risks like pain and infection. Mitotane can cause significant side effects such as nausea, vomiting, fatigue, and neurological issues. Chemotherapy can lead to hair loss, fatigue, and increased infection risk. Your care team will help manage these.

Can adrenal cancer spread to other parts of the body?

Yes, adrenal cancer, especially adrenocortical carcinoma, can spread (metastasize) to other parts of the body. Common sites for spread include the liver, lungs, and bones. The stage of the cancer at diagnosis indicates whether it has spread and influences treatment decisions.

Sources

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