Adrenal cancer, also known as adrenocortical cancer, occurs when malignant cells grow in the outer layer of the adrenal gland. Cancer can also occur in the adrenal medulla, which is an extension of the nervous system. The tumors can either be benign (most often pheochromocytomas) or malignant (neuroblastomas). Adrenal gland cancer is a rare disease, affecting 0.72 out a million people annually.
Adrenal Gland Function
The adrenal glands are small, triangle-shaped organs that sit on the top of each kidney. They have two parts: an outer layer (adrenal cortex) and a middle layer (adrenal medulla). The cortex functions by producing certain hormones for the body.The adrenal glands produce hormones that have many functions in the body, including:
- Balancing the levels of salt and water in the body
- Keeping the blood pressure within a normal range
- Regulating the body’s use of carbohydrates, fats, and protein
- Maintaining male and female characteristics
Up to 80 percent of tumors in the adrenal cortex are functioning, which means that the tumors produce excess amounts of one or more of the following hormones:
- Estrogen (only in small part; the ovaries produce most of this hormone in women)
- Testosterone (only a tiny amount; the testicles produce most of this hormone in men)
- Cortisol (generates changes in metabolism so that the body can deal with stress)
- Aldosterone (manages blood pressure and assists the kidneys in regulating the amount of salt in the blood)
Nonfunctioning tumors, which do not produce hormones, may not cause any symptoms during the early stages of the adrenal cancer.
Adrenal Cancer Symptoms
Adrenal cancer symptoms include a lump or feeling of fullness in the abdomen, or pain in the back or abdomen.In 60 percent of people with this condition, the main symptoms are caused by an excess of hormones released by the tumor cells.
The exact symptoms depend upon the excess hormones produced.
- Too much cortisol may cause weight gain in the torso, neck, and face; high blood sugar; high blood pressure, muscle weakness; a round, red, full face.
- Too much aldosterone may cause muscle weakness or cramps; frequent urination; high blood pressure; thirstiness.
- Too much testosterone (in women) may cause acne; balding; loss of menstrual periods; hair growth on the face (men with too much testosterone don’t usually have symptoms).
- Too much estrogen (in women) may cause vaginal bleeding after menopause; irregular periods before menopause; weight gain.
- Too much estrogen (in men) may cause decreased sex drive; impotence; growth of breast tissue.
Adrenal Cancer Diagnosis
Several methods and tests may be used to diagnose adrenal cancer, including:
- Physical exam and history: Exam to check for signs of disease in the body, such as lumps; review of the patient’s history of symptoms, health habits, past illnesses and treatments.
- Urine tests: Urine collected over 24 hours is tested for excess amounts of hormones produced by the adrenal glands (17-ketosteroids or cortisol).
- Low-dose (or high-dose) dexamethasone suppression test: Done with either urine or blood collected for three days, this test is used to check the cortisol levels in the body.
- Blood chemistry test: A test done to check the levels of potassium, sodium, and other substances in the blood.
- CT scan (aka CAT scan): An imaging test that uses an x-ray machine connected to a computer to look for unusual masses inside the body. A special dye may be injected into a vein to make the organs and tissues show up better on the image.
- MRI (magnetic resonance imaging): An imaging test that uses large magnets connected to a computer to identify unusual masses inside the body.
- Adrenal venography: A test that uses x-rays and a special dye to look at the flow of blood in and near the adrenal glands.
- PET (positron emission tomography) scan: A small amount of radioactive sugar (glucose) is injected into a vein. Tumor cells, which are more active than normal cells, use the glucose faster. A scanner is able to identify possible tumors by how much glucose the cells use.
- MIBG scan: A small amount of radioactive material is injected into a vein. Adrenal gland cells take up this material, which allows doctors to tell apart a tumor in the adrenal cortex from one in the adrenal medulla.
- Biopsy: A small sample of tissue is taken with a thin or wider needle. A pathologist (special doctor) examines the tissue for signs of cancer cells, as well as to determine the tumor’s grade (aggressiveness) and stage (how far advanced).
Adrenal Cancer Stages
Staging involves determining how far advanced a tumor is. This includes the size of the tumor and whether it has spread to other locations from the initial (primary) site.
Cancer can spread through the body by invading surrounding normal tissue. Adrenal cancer cells can also migrate to distant areas (metastasis) through the blood or the lymph system (part of the body’s immune system).
The stages of adrenal cancer are:
- Stage I: Tumor is 5 centimeters or less and is found only in the adrenal gland.
- Stage II: Tumor is larger than 5 centimeters and is found only in the adrenal gland.
- Stage III: Tumor can be any size. It has spread to the lymph nodes or fat near the adrenal gland; or to tissues near the adrenal gland (but not to nearby organs).
- Stage IV: Tumor can be any size. It has spread to the lymph nodes, fat, and tissues near the adrenal gland; or to organs near the adrenal gland (and maybe nearby lymph nodes); or to other parts of the body, such as the lungs or liver.
Adrenal cancer treatments are available, and the best option will depend on the stage in which the cancer was initally discovered.
References
Allolio B, Fassnacht M. (2010). Clinical presentation and initial diagnosis. Adrenocortical Carcinoma: Basic Science and Clinical Concepts.
Fassnacht M, Allolio B. (2010). Epidemiology of adrenocortical carcinoma. Adrenocortical Carcinoma: Basic Science and Clinical Concepts.
Bilimoria KY, Shen WT, Elaraj D, et al. (2008). Adrenocortical carcinoma in the United States: treatment utilization and prognostic factors. Cancer 113 (11):3130-6.
