Adrenal gland cancer

What is adrenal gland cancer (pheochromocytoma)?

Adrenal gland cancer (adrenal cancer) is a rare cancer that begins in one of the small, triangular-shaped glands (adrenal glands) located above the kidneys. The adrenal glands produce hormones that instruct nearly every organ and tissue in the body. While it can occur at any age, adrenal gland cancer predominantly affects children under the age of 5 and individuals in their 40s and 50s. Early diagnosis allows for effective treatment of adrenal gland cancer, but the chances of successful treatment decrease when the cancer has metastasized.

Most tumors that form in the adrenal glands are not cancerous; they can also be benign tumors. Benign tumors such as adenomas or pheochromocytomas can develop in the adrenal glands. Determining whether a tumor in the adrenal gland is cancerous or benign is often challenging. Benign tumors do not spread, while cancerous tumors can spread to lymph nodes or other areas of the body.

Tumors that originate in the adrenal glands can be categorized as follows:

1. Adenoma: This is the most common type of adrenal gland tumor. It is not cancerous; rather, it's a benign mass.

2. Adrenal Cortical Cancer (Adrenal Cortical Carcinoma): This is a rare tumor, but it constitutes the most common type of cancerous adrenal gland tumor.

3. Pheochromocytoma: This is a tumor that originates in the hormone-producing part (medulla) of the adrenal glands. In most cases, it is not cancerous.

4. Neuroblastoma: This cancerous tumor most frequently starts in the adrenal glands in children. However, it can also originate in the neck, chest, or spinal cord.

Why does a mass or tumor form in the adrenal gland?

The exact causes of adrenal gland cancer are not fully understood. Although not definitive, studies suggest that mutations occurring in DNA might lead to the transformation of cells in the adrenal gland into cancerous ones. It is presumed that adrenal gland cancer arises when mutations occur in the DNA of an adrenal gland cell. Tumor cells can break apart and spread to other areas of the body.

What are the symptoms of adrenal gland cancer?

The question "how is adrenal gland cancer recognized" is among the most frequently asked questions. Symptoms of adrenal gland cancer are often caused by the hormones produced by the tumor. Some symptoms emerge when the tumor is quite large and exerts pressure on nearby organs.

Signs and symptoms of adrenal gland tumors include:

• Unexplained weight gain or weight loss

• Muscle weakness

• Red to purplish-pink stretch marks on the skin

• Hormonal changes that can lead to increased facial hair, hair loss on the head, and menstrual irregularities in women

• Hormonal changes that can cause breast tissue enlargement and testicular shrinking in men

• Nausea, vomiting

• Abdominal or back pain

• Fever

• Loss of appetite

• Formation of stretch marks on the abdomen

• Muscle cramps

• Headaches

• Feeling of fullness in the abdomen or feeling full after eating only a small amount

• Sexual problems

• Fatty areas on the shoulders and the back of the neck

• Low potassium levels

• Anxiety or new panic attacks

• High blood pressure

• Diabetes

How is adrenal gland cancer detected? How is it diagnosed?

To diagnose adrenal gland cancer, a specialist physician first performs a physical examination. After obtaining the patient's medical history and listening to their symptoms, if there is a suspicion of cancer, certain tests need to be conducted. These tests can be listed as follows:

Blood and Urine Tests: These tests detect unusual hormone levels produced by the adrenal glands, such as cortisol, aldosterone, and androgens, in the blood and urine.

Imaging Tests: Imaging tests like MRI, CT scan, and PET-CT are used to detect any growth in the adrenal glands and to determine whether the tumor has spread to other parts of the body.

Biopsy and Pathology Tests: If there is suspicion of adrenal gland cancer, a biopsy sample is taken and analyzed pathologically to provide information about the content of the tumor.

What are the treatment options for adrenal gland cancer?

The treatment for adrenal gland cancer can vary based on the type of cancer, test results, and the stage of the cancer. The goal of treatment can be to cure the patient, control the cancer depending on its stage, and alleviate the discomfort caused by the cancer. Typically, the treatment of this disease involves surgery to remove the entire cancer.

Surgery: The primary treatment for adrenal gland cancer is the removal of the adrenal gland through a procedure called adrenalectomy. The surgeon aims to remove the cancer, including any areas it may have spread to. Nearby lymph nodes must be checked for spread and removed if necessary. While one approach involves an incision on the back to remove the adrenal gland, this method can be challenging for viewing large tumors. As a result, the surgery is usually performed through the front of the abdomen. This method provides better visualization of the tumor and its potential spread. In cases of metastasized cancer, other organs may also need to be partially or entirely removed during this procedure.

For small adrenal tumors, laparoscopic removal is also possible. While laparoscopic surgery can be used to treat benign tumors, it's generally not suitable for larger adrenal gland cancers. This is because these cancers often need to be removed in fragments rather than as a whole, which could increase the risk of cancer spread.

Radiation therapy: Radiation therapy is not typically used as the primary treatment for adrenal cancer, as killing cancer cells with x-rays can be challenging. However, radiation therapy can sometimes be used to kill remaining cancer cells after adrenal cancer surgery or to prevent the tumor from returning. This is known as "adjuvant" therapy. Radiation can also be used to treat areas where cancer has spread, like bones or the brain, and to help reduce cancer symptoms.

Chemotherapy: Chemotherapy involves using specific types of drugs to kill cancer cells. Typically, these drugs are administered intravenously or orally (in pill form). These drugs enter the bloodstream and can be effective for cancers that have spread (metastasized) beyond the adrenal gland, reaching other parts of the body. For adrenal cancers that cannot be removed surgically or return after initial treatments, chemotherapy can be an option to slow down cancer progression.

Use of medications to reduce the risk of recurrence: After surgically removing all visible cancer, patients might receive adjuvant therapy for a period to target any remaining microscopic cells.

Medications to control hormone levels: Often, patients need hormone replacements after adrenal gland removal. These medications can be used to block hormones produced by the cancer or reduce the effects of hormones. Treatment with some of these medications should be overseen by an endocrinologist.

FREQUENTLY ASKED QUESTIONS ABOUT ADRENAL GLAND CANCER