Adrenal cancer treatments will be needed when malignant cells grow in the outer (cortex) or inner (medulla) layer of the adrenal glands, the triangle-shaped organs that rest atop of each kidney. The cortex, which functions by producing corticosteroid and androgen hormones for the body, is where most adrenal cancer starts. Also referred to as adrenocortical cancer, persons with certain hereditary diseases such Beckwith-Wiedemann syndrome or Li-Fraumeni syndrome, are at an increased risk of developing this rare type of adrenal gland cancer.
In more than 50 percent of people, adrenal cancer symptoms—including frequent urination, decreased sex drive, impotence, and the development of breast tissue in men—are sparked by an excess of hormones released by the tumor cells. While malignant cells can form in the adrenal medulla, the layer is an extension of the nervous system. Adrenal cancer treatment includes surgery, radiation therapy, and chemotherapy. Additional adrenal treatment options, including biologic therapy and targeted therapy, are currently being tested in clinical trials.
Traditional Adrenal Cancer Treatments
Complete removal of the affected adrenal gland (adrenalectomy) is the main treatment option for adrenal cancer. The standard technique is open surgery, in which a large cut (incision) is made in the belly so that the kidney and adrenal gland can be accessed for removal. Some studies have shown that laparoscopy—inserting tools and a tube with a camera and light source through several smaller incisions—may work for smaller tumors when the cancer has not spread.
If the cancer has metastasized to the lymph nodes or nearby tissues, they too can be excised and extracted during surgery. Other locations in which the cancer can spread are the liver, lungs, and bone.
Radiation therapy uses radiation (either high-energy x-rays, or other types) to kill the cancer cells or keep them from growing. The choice of treatment depends upon the stage of the cancer, and includes:
- External radiation therapy: radiation from a machine outside the body is directed toward the cancer.
- Internal radiation therapy: a radioactive substance is placed near or into the cancer. This substance is sealed inside seeds, wires, needles, or catheters.
Chemotherapy is a type of treatment that uses potent drugs to kill the cancer cells or prevent them from multiplying. The choice of treatment depends upon the stage of the cancer, and the drugs may be:
- Taken by mouth: The drugs enter the bloodstream through the digestive system and then reaches the cancer cells
- Injected into a vein: The drugs reach the cancer cells through the blood
- Placed directly near the cancer cells
This treatment may also be done using several drugs, in what’s known as combination chemotherapy.
Alternative Treatments for Adrenal Cancer
Other treatments are currently being tested in clinical trials. These options may not be available to every patient, but include:
- Biologic therapy (also known as immunotherapy or biotherapy): Substances made in a laboratory or by the body are used to help the patient’s immune system fight the cancer
- Targeted therapy: Drugs or other substances are used to label and attack certain types of cancer cells while leaving normal cells untouched
Treating Adrenal Cancer by Stage
The best choice of treatment option depends, in part, on the stage of the cancer.
- Stages I, II, and III treatment may include surgery (adrenalectomy), with removal of nearby lymph nodes if they are enlarged; or a new treatment in a clinical trial
- Stage IV treatment may include chemotherapy; radiation therapy for the bones and other areas where the cancer has spread; surgery to remove cancer cells in other tissues near the adrenal gland; or new treatments like biologic therapy, chemotherapy, or targeted therapy that are being tested in a clinical trial
Adrenal Cancer Treatment Prognosis
The success of treatment and chance of recovery (prognosis) from adrenal gland cancer depends upon several factors:
- The cancer’s stage: This includes the size of the tumor and whether the cancer cells have spread to nearby tissues or distant parts of the body (metastasis)
- The possibility of removing the tumor completely during surgery
- Previous treatments: If adrenal cancer comes back (recurs), the cancer may show up in the adrenal cortex or in other parts of the body (which are more difficult to treat)
- Overall health of the patient
- The tumor’s grade: an indication of how aggressively it is likely to grow
If diagnosed and treated early, adrenal cancer may be cured. In patients with only local tumors who have the tumor removed completely during open surgery, the 5-year survival rate of 38 percent to 46 percent.
Later stages, however, are more difficult to treat. The survival rate for adrenal cancer at five years for patients with stage IV tumors is less than 20 percent.
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Kazaryan AM, Marangos IP, Rosseland AR, et al. (2009). Laparoscopic adrenalectomy: Norwegian single-center experience of 242 procedures. J Laparoendosc Adv Surg Tech A 19(2):181-9.