ADRENAL TUMOR

Adrenal cancer is a condition that occurs when abnormal cells form in or travel to the adrenal glands. Your body has two adrenal glands, one located above each kidney. Adrenal cancer usually occurs in the outermost layer of the glands, or the adrenal cortex. It usually appears as a tumor.

A cancerous tumor of the adrenal gland is called an adrenal cortical carcinoma. A noncancerous tumor of the adrenal gland is called a benign adenoma.

Benign adenomas are relatively small, usually less than 2 inches in diameter. Most people with this type of tumor have no symptoms. These benign tumors usually occur on only one adrenal gland, but they can appear on both glands in rare instances.

Adrenal cortical carcinomas are usually much larger than benign adenomas. If a tumor is more than 2 inches in diameter, it’s more likely to be cancerous. Sometimes, they can get large enough to press on your organs and cause more symptoms. They can also sometimes produce hormones that cause changes in the body.

If you have cancer in the adrenal glands, but it didn’t originate there, it’s not considered an adrenal cortical carcinoma. Cancers of the breast, stomach, kidney, skin and lymphoma are most likely to spread to the adrenal glands.

What causes tumors on the adrenal glands?

Cushing syndrome may be caused by an adrenal cancer or an adrenal adenoma that produces high levels of cortisol and/or related hormones. Benign pituitary gland tumors can produce high levels of another hormone called adrenocorticotropic hormone (ACTH). This is often called Cushing disease.

What is a nodule on the adrenal gland?

There are two adrenal glands, located on top of each kidney. Nodules that occur on the adrenal glands are often found during a scan or ultrasound that is being done for another unrelated medical reason. Most adrenal nodules are benign (non-cancerous).

How rare is adrenal gland cancer?

Adrenocortical carcinoma is a rare tumor afflicting only one or two persons per one million population. It usually occurs in adults, and the median age at diagnosis is 44 years. Although potentially curable at early stages, only 30% of these malignancies are confined to the adrenal gland at the time of diagnosis.

Where are the adrenal gland?

The adrenal glands are small glands located on top of each kidney. They produce hormones that you can't live without, including sex hormones and cortisol. Cortisol helps you respond to stress and has many other important functions.

What Are the Symptoms of Adrenal Cancer?

Symptoms of adrenal cancer are caused by the excess production of the hormones. These are typically androgen, estrogen, cortisol, and aldosterone. Symptoms may also arise from large tumors pressing on organs of the body.

Symptoms of excessive androgen or estrogen production are easier to spot in children than adults because physical changes are more active and visible during puberty. Some signs of adrenal cancer in children can be:

• excessive pubic, underarm, and facial hair growth

• an enlarged penis

• an enlarged clitoris

• large breasts in boys

• early puberty in girls

In about half the people with adrenal cancer symptoms don’t appear until the tumor is large enough to press on other organs. Women with tumors that cause increases in androgen may notice facial hair growth or deepening of the voice. Men with tumors that cause increases in estrogen may notice breast enlargement or breast tenderness. If the excess hormones are typically found in that person, like estrogen in women and androgen in men, diagnosing the tumor becomes more difficult.

Some other symptoms of adrenal cancer that produce excess cortisol and aldosterone in adults can include:

• high blood pressure

• high blood sugar

• weight gain

• irregular periods

• easy bruising

• depression

• frequent urination

• muscle cramps

What Are the Risk Factors for Adrenal Cancer?

At this point, scientists don’t know what causes adrenal cancer. According to the American Cancer Society, about 85% of adrenal cancers happen for unknown reasons. About 15% of these cancers are caused by a genetic disorder. Certain conditions can put you at an increased risk of developing adrenal cancer.

These include:

• Beckwith-Wiedemann syndrome, which is an abnormal growth disorder marked by a large body and organs; individuals with this syndrome are also at risk for cancer of the kidney and liver.

• Li-Fraumeni syndrome, which is an inherited disorder that causes an increased risk for many types of cancers.

• familial adenomatous polyposis (FAP), which is an inherited condition characterized by large numbers of polyps in the large intestines that also carries a high risk of colon cancer.

• multiple endocrine neoplasia (MEN1), which is an inherited condition that causes many tumors to develop, both benign and malignant, in tissues that produce hormones like the pituitary, parathyroid and pancreas.

Smoking likely also increases the risk of adrenal cancer, but there’s no conclusive proof yet.

How is Adrenal Cancer Diagnosed?

Diagnosing adrenal cancer usually begins with your medical history and a physical exam. Your doctor will also draw blood and collect a urine sample for testing.

Doctor may order further tests such as:

• an image-guided fine needle biopsy

• an ultrasound

• a CT scan

• a positron emission tomography (PET) scan

• an MRI scan

• an adrenal angiography

What Are the Treatments for Adrenal Cancer?

Early treatment can sometimes cure adrenal cancer. There are currently three major types of standard treatment for adrenal cancer:

Surgery

Your doctor may recommend a procedure called an adrenalectomy, which involves removing the adrenal gland. If the cancer has spread to other parts of the body, your surgeon may also remove nearby lymph nodes and tissue.

Radiation Therapy

This treatment uses high-energy X-rays to kill cancer cells and stop new cancer cells from growing.

Chemotherapy

Depending on the stage of your cancer, you may need to undergo chemotherapy. This form of cancer drug therapy helps stop the growth of cancer cells. Chemotherapy can be administered orally or injected into a vein or muscle.

Your doctor may combine chemotherapy with other types of cancer treatments.

Other Treatments

Ablation, or the destruction of tumor cells, may be necessary for tumors where it is unsafe to remove them surgically.

Mitotane is the most common drug used in the treatment of adrenal cancer. In some cases it is given after surgery. It can block excessive hormone production and can may help decrease the size of the tumor.

You can also discuss clinical trial treatments with your doctor, such of biologic therapy, which uses the immune system to fight cancer cells.

What Is the Long-Term Outlook?

If you are diagnosed with adrenal cancer a team of doctors will work with you to coordinate your care. Follow-up appointments with your doctors are very important if you’ve had adrenal tumors in the past. Adrenal cancer can come back at any time and it is important to stay in close contact with your medical team.