Adrenal Cancer

Adrenal cancer is a very rare, aggressive cancer of the adrenal glands. There are two adrenal glands, each one located on top of each kidney. Adrenal glands make hormones including adrenaline (epinephrine, norepinephrine), steroids (cortisol), aldosterone, as well as others. Adrenal cancer arises from the outer layer of the adrenal gland called the cortex. Only about six hundred new cases are diagnosed in the United States each year.

This cancer tends to develop in patients younger than 10 or in patients between the ages of 50 and 60. Children are generally diagnosed at an early stage of the cancer because symptoms are more pronounced in children. Therefore, children generally have a better prognosis than adults. In many cases, adrenal cancer in adults will recur. When adrenal cancer has recurred, it may be treated by more surgery and chemotherapy, but long term is generally fatal.


Causes of Adrenal Cancer

Researchers do not yet know what causes adrenal cancer. More is understood about certain changes that take place in the DNA that may cause cells in the adrenal gland to become cancerous. What causes DNA to change can be genetic, but most changes occur during a person’s lifetime, such as exposure to radiation or cancer-causing agents. Most of the time, these DNA changes happen due to unknown reasons.


Risk Factors

A risk factor is anything that increases a person's chance of getting a disease. Different diseases have different risk factors. Some risk factors can be controlled with lifestyle changes. Other risk factors cannot be changed.

Certain syndromes can cause a higher risk for getting adrenal cancer. These include: 
  • Li-Fraumeni syndrome 
  • Beckwith-Wiedemann syndrome 
  • Multiple endocrine neoplasia (MEN-1) 
  • Familial adenomatous polyposis (FAP)
Research suggests that smoking may contribute to having a higher risk factor for developing adrenal cancer. 

Having any of these risk factors does not mean that you will develop adrenal cancer, but understanding your risk factors will help you and your doctor take any necessary steps to monitor your health.
  • Body’s organs, which creates an energy that can be read by the PET machine and created into three-dimensional images with the aid of a computer. 
  • Nuclear scintigraphy. A nuclear scintigraphy is a non-invasive imaging test that uses radioactive elements, called radionuclides, which are sometimes attached to drugs that travel to specific organs. The radioactive elements emit gamma radiation that can be viewed by a specialized gamma camera to determine if cancer has spread beyond the original tumor site.


Symptoms

In many cases, the symptoms associated with adrenal cancer are those caused by hormonal changes in the body. In other cases, symptoms arise when the tumor has grown large enough or quickly enough to press against other organs. These symptoms include abdominal pain, pains in the side, a feeling of fullness in the belly, or trouble eating because the stomach feels full quickly. 

In general, there are no obvious signs when an adult has adrenal cancer because symptoms mimic other common middle-aged conditions, such as high blood pressure, diabetes, and weight gain. In early stages, the tumor may not cause any symptoms. 

The symptoms listed below are grouped according to the hormones that would cause them. 

Symptoms caused by the hormones: androgen or estrogen 

These tumors tend to produce the male hormones, known as androgens. The symptoms are most apparent in children and women: 
  • Enlargement of the penis (boys) 
  • Enlargement of the clitoris (girls) 
  • Excess growth of facial, pubic, and underarm hair in children 
  • Excess facial hair or scalp hair loss in women
  • Irregular periods 
  • Deepening of the voice in women
If the tumor creates more female hormones, known as estrogens, the following symptoms may be present: 
Early puberty in girls (having periods and the breasts getting larger) 
Breast enlargement in males (including boys) 
Decreased sex drive in men, or trouble getting an erection

Women generally have no symptoms unless the tumor is large enough to press on nearby organs. 

Symptoms caused by high levels of cortisol 

When cortisol is in excess, the group of accompanying symptoms is referred to as Cushing’s syndrome. Some of these symptoms include: 
  • Fat deposits behind the neck and shoulders 
  • Weight gain, often around the chest and stomach 
  • Purple stretch marks on the stomach 
  • Hair growth on the face, chest, and back in women 
  • Irregular periods 
  • Weakness in the legs 
  • Easy bruising 
  • Depression or moodiness 
  • Weak bones, which can lead to broken bones 
  • High blood sugar, often leading to diabetes 
  • High blood pressure
Symptoms caused by high aldosterone levels 

Excess aldosterone often causes the following: 
  • High blood pressure 
  • Weakness 
  • Muscle cramps 
  • Increased thirst
  • Urinating very often
It is important to understand that having one or more of the symptoms above does not mean that you have adrenal cancer. Many of these symptoms can be caused by benign conditions that affect the endocrine system. If you think you may have adrenal cancer, please contact your doctor.


Treatment

Surgical removal of an adrenal gland, or adrenalectomy, is most commonly performed for a tumor located within the adrenal gland that is cancerous. If both adrenal glands need to be removed, then patients will need to take medications to replace the hormones that would normally be excreted by the adrenal glands. If the cancer has spread, other treatments may also be suggested, including chemotherapy and radiation. 

Surgical Treatment
Adrenalectomy
In a traditional adrenalectomy, an incision is made over the abdomen or side in order to provide direct access to the adrenal gland. A laparoscopic adrenalectomy requires smaller incisions. During a laparoscopic procedure, three to four half-inch incisions are made, and surgeons use a camera for visual guidance and special instruments to remove the adrenal gland or glands. With a laparoscopic adrenalectomy, most patients go home within 24 to 72 hours and experience less postoperative discomfort and a shorter recovery time than patients who have a traditional adrenalectomy. The majority of our adrenalectomies are performed using laparoscopic methods. 

Non-Surgical Treatment 
Some patients may not be able to have their tumors treated surgically because of the way it is growing or if it is cancerous and has spread to other parts of the body. In these cases, the patient should work with their endocrinologist and oncologist to determine the best course of treatment.