Adrenal Gland Cancer
Adrenal cancer is a growth of cells that starts in an adrenal gland. The adrenal glands are small, triangular glands located on top of the kidneys. Although small, these glands control much of what happens in the body. They make hormones that help control metabolism, blood pressure and other important functions.
Adrenal cancer is rare, and it can happen at any age. It’s most likely to affect children younger than 5 and adults in their 40s and 50s. Adrenal cancer also is called adrenocortical carcinoma.
When adrenal cancer is found early, a cure may be possible. When the cancer has spread beyond the adrenal glands, a cure becomes less likely. In that situation, treatment may be used to keep the cancer from spreading more.
Most growths that form in the adrenal glands are not cancer. The medical term for that is benign. An example of an adrenal growth that is not cancer is adrenal adenoma.
Signs and symptoms of adrenal cancer may include:
- Back pain.
- Belly pain.
- Losing weight without trying.
- Loss of appetite.
Many people who have adrenal cancer develop hormone changes in the body. These changes can happen if the cancer cells make extra hormones. Most often, the adrenal cancer makes the hormone cortisol. This can cause symptoms of Cushing syndrome, including:
- Weight gain.
- Muscle weakness.
- Pink or purple stretch marks on the skin.
- Bruises that happen even with a small injury.
- High blood pressure.
- High blood sugar or diabetes.
Less often, an adrenal cancer might make the sex hormones estrogen and testosterone. In females, changes in the sex hormones can cause extra facial hair, hair loss on the head and periods that aren’t regular. In males, these hormone changes may cause the testicles to shrink and breast tissue to get bigger.
Rarely, adrenal cancer may make the hormone aldosterone. That can cause high blood pressure and low levels of potassium in the blood.
Make an appointment with a healthcare professional if you have any symptoms that worry you.
It’s not clear what causes adrenal cancer.
Adrenal cancer happens when cells in the adrenal gland develop changes in their DNA. A cell’s DNA holds the instructions that tell the cell what to do. In healthy cells, the DNA tells the cells to grow and multiply at a set rate. The DNA also tells the cells to die at a set time.
In cancer cells, the DNA changes give different instructions. The changes tell the cancer cells to grow and multiply quickly. Cancer cells can keep living when healthy cells would die. This causes too many cells.
The cancer cells might form a mass called a tumor. The tumor can grow to invade and destroy healthy body tissue. In time, cancer cells can break away and spread to other parts of the body. When cancer spreads, it’s called metastatic cancer.
Adrenal cancer happens more often in people who inherit certain health conditions that raise the risk of some cancers. Those health conditions include:
- Beckwith-Wiedemann syndrome.
- Familial adenomatous polyposis.
- Li-Fraumeni syndrome.
- Lynch syndrome.
- Multiple endocrine neoplasia, type 1, also called MEN 1.
Healthcare professionals haven’t found anything that can prevent adrenal cancer.
To diagnose adrenal cancer, a healthcare professional might start with a physical exam and review of your health history and family medical history. Diagnosis also involves blood and urine tests and imaging tests. Sometimes, surgery to remove the adrenal gland may be needed to diagnose adrenal cancer.
Blood and urine tests
Lab tests of blood and urine may show levels of hormones made by the adrenal glands that are outside a healthy range. Those hormones include cortisol, aldosterone and androgens.
Imaging tests
Imaging tests used to diagnose adrenal cancer include CT, MRI and positron emission tomography scans, also called PET scans. Healthcare professionals might use the images to examine growths on the adrenal glands. Imaging tests also can look for signs that the cancer has spread to other areas of the body.
Surgery to remove the adrenal gland
In some situations, to make a diagnosis of adrenal cancer, the adrenal gland that might have cancer is removed with surgery. Then, the gland is examined in a lab by a doctor who studies body tissues, called a pathologist. Testing can show whether the gland has cancer.
Treatment for adrenal cancer often includes surgery to remove the adrenal gland. Other treatments also might be used in some situations. Those treatments include radiation therapy and medicines, such as chemotherapy and immunotherapy.
Surgery
Surgery for adrenal cancer typically involves removing the entire adrenal gland. This procedure is called an adrenalectomy. The surgery is done for several reasons, including to:
- Confirm a diagnosis of adrenal cancer.
- Remove as much of the cancer as possible.
- See if cancer has spread outside the adrenal gland.
- Ease symptoms. This can include lessening symptoms that happen when the body makes too much of the hormone cortisol due to cancer. Surgery also may help with symptoms such as belly pain and back pain that happen when an adrenal cancer grows large.
It’s common for adrenal cancer to spread outside of the adrenal gland. If the surgeon finds evidence that the cancer has spread to nearby organs, such as to the liver or kidney, parts or all of those organs also might need to be removed.
Radiation therapy
Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources. Radiation therapy sometimes is used after adrenal cancer surgery to kill any cells that might be left behind. It also can help ease pain and other symptoms of cancer that has spread to other parts of the body, such as the bones.
Chemotherapy
Chemotherapy treats cancer with strong medicines. For adrenal cancers that can’t entirely be removed with surgery or those that come back after surgery, chemotherapy may help keep the cancer from growing and spreading.
Mitotane
Mitotane (Lysodren) is an older medicine that has been used to treat advanced adrenal cancer. It also has shown promise in keeping adrenal cancer from coming back after surgery. Mitotane may be used after surgery for people who are at high risk of the cancer coming back. Research into mitotane for this purpose is ongoing.
Immunotherapy
Immunotherapy for cancer is a treatment with medicine that helps the body’s immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn’t be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells.
For adrenal cancer, immunotherapy may be used when the cancer has spread to other parts of the body or in situations where surgery isn’t possible.
References
- DeVita VT Jr, et al., eds. Adrenal tumors. In: DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 12th ed. Wolters Kluwer; 2023. Accessed Oct. 18, 2024.
- Adrenocortical carcinoma treatment (PDQ) – Patient version. National Cancer Institute. https://www.cancer.gov/types/eye/patient/intraocular-melanoma-treatment-pdq#section/all. Accessed Nov. 12, 2024.
- Neuroendocrine and adrenal tumors. National Comprehensive Cancer Network. https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1448. Accessed Oct. 18, 2024.
- Lacroix A. Clinical presentation and evaluation of adrenocortical tumors. https://www.uptodate.com/contents/search. Accessed Nov. 14, 2024.
- Lacroix A, et al. Treatment of adrenocortical carcinoma. https://www.uptodate.com/contents/search. Accessed Nov. 14, 2024.
- Taking time: Support for people with cancer. National Cancer Institute. https://www.cancer.gov/publications/patient-education/taking-time. Accessed Nov. 15, 2024.
- Mizdrak M, et al. The role of biomarkers in adrenocortical carcinoma: A review of current evidence and future perspectives. Biomedicines. 2021; doi:10.3390/biomedicines.
- Medical review (expert opinion). Mayo Clinic. Dec. 4, 2024.
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