Adrenal Tumors and Adrenal Cancer

How are adrenal tumors diagnosed?

If you have signs or symptoms of an adrenal tumor or cancer, your doctor will collect information about your medical history and your family history of cancer. They'll also conduct a physical exam and may order additional tests, such as:

• Biopsy: A small amount of tissue from the adrenal gland may be removed with a fine needle to examine it for any evidence of cancer. We reserve this for patients who have advanced adrenal tumors that appear to be cancer and cannot be removed surgically to make the diagnosis of cancer or for patients who have cancers in other parts of the body that appear to have spread to the adrenal gland.

• Blood and urine tests: Hormone levels produced under certain circumstances are present in blood and urine and may indicate possible tumors.

• Imaging: With either a computed tomography (CT) scan or MRI, your physician can verify the existence of an adrenal tumor and determine its exact size and placement.

• Metaiodobenzylguanidine scan (MIBG): This is a special test administered during the course of two days. It is designed to show adrenal tumors that are not evident on other scans. On the first day, a patient gets an injection followed by a scan with a special camera. The next day, the scan is repeated.

• Adrenal vein sampling: This test can allow us to figure out which of the adrenal glands is overproducing hormones, either in patients with tumors of both glands or with hyperplasia (overgrowth) of the glands that do not clearly have a tumor.

The kidneys, responsible for cleaning and purifying the blood, are located inside the upper part of the abdomen. Sitting above each of the kidneys, you will find the adrenals, small glands made up of two parts:

1. Cortex: The outer part of the gland, which produces important hormones for the body.
2. Medulla: The inner part of the gland, which is an extension of the nervous system.

The adrenal cortex is where tumors and cancers can develop; however, they are rare, and most are benign (non-cancerous). Two main types of adrenal cortex tumors exist:

1. Adenomas: Most tumors of the adrenal cortex are benign adenomas. These are small tumors, usually less than 5 centimeters (about 2 inches) in diameter. They usually occur in only one adrenal gland, but sometimes affect both glands.
2. Carcinoma: The type of cancer that develops in the cortex of the adrenal gland is called adrenal cortical carcinoma. Generally, adrenal cortical cancers are much larger than adrenal adenomas. An adrenal tumor larger than 5 or 6 centimeters (about 2-2.5 inches) is usually malignant or cancerous. In one study, the average size was about 4-5 inches.

The most common subtypes of adrenal tumors include:

• Adrenocortical carcinoma, a rare disease in which cancer forms in the cortex (outer layer) of an adrenal gland.
• Adrenal cortex tumors, which produce excessive cortisol (stress hormone) and may cause a condition called Cushing’s syndrome.
• Aldosteronomas, tumors that produce excessive aldosterone and commonly cause Conn syndrome, or hyperaldosteronism.
• Incidentalomas, enlarged adrenal glands that have a risk of being adrenal cancer.
• Pheochromocytoma, a type of neuroendocrine tumor (made up of both nerve and hormone producing cells), is a rare and usually benign tumor that develops in cells in the center of an adrenal gland. This type of tumor is genetic and runs in families.

How are adrenal cancers and tumors treated?

If you have an adrenal tumor, your treatment is based on the tumor's size, location, and whether or not it is cancerous. A team of experts will work together to design a treatment plan based on your unique needs, with input from specialists in endocrinology, surgery, medical oncology, radiation oncology, interventional radiology, and nuclear medicine, when appropriate.

Surgery

For most patients, surgery to remove the adrenal gland is the best treatment option. It can be used alone or, in some cases of adrenal cancer, in combination with radiation or chemotherapy. When additional therapies are needed, our endocrine surgical team works collaboratively with other specialists at MedStar Health to develop a comprehensive treatment plan.

Some patients will be treated with open surgery. This is traditionally used for larger adrenal tumors or tumors attached to other nearby organs. It requires larger incisions, usually made through the abdomen.

Our surgeons are particularly skilled at a less-invasive surgical procedure that is an option for an increasing number of patients called a laparoscopic adrenalectomy. In this procedure, adrenal tumors are removed through small incisions measuring one to two centimeters along the abdominal wall. This speeds recovery, minimizes scarring, and lowers the risk of injury to abdominal organs.

Chemotherapy

Chemotherapy uses drugs to target cancerous cells throughout the body. If you have an advanced form of adrenal cancer and/or are not a good candidate for surgery, chemotherapy may be used to treat your disease. The most common type of chemotherapy used for adrenal cancer is taken orally via a pill, either alone or in combination with other drugs. If this is an appropriate treatment option for you, your care team will monitor your body's response to it and help you manage any side effects as you undergo treatment.

Learn More About Chemotherapy

Hormone therapies

Depending on your adrenal tumor type, your doctors may recommend drugs that block or reduce the effects of hormones. This can help to relieve side effects of cancerous tumors.

Immunotherapy and targeted therapy

Immunotherapy leverages the body's own immune system to target and change how cancerous cells grow. While this treatment is more commonly used to treat other types of cancer, it was recently approved for use in certain cases of metastatic adrenal cancer.

Learn More About Immunotherapy

Learn More About Targeted Therapy

Radiation therapy

Radiation therapy uses high-energy X-rays or particles to pinpoint and destroy cancer. While radiation therapy is a common treatment for other types of cancer, it is not frequently used as a main treatment for adrenal cancer. However, it may be appropriate in certain instances, such as after surgery to kill any remaining cancerous cells or if cancer has spread to the bones or brain. With access to all of the latest technologies in radiation therapy, our radiation oncologists are skilled at using the most advanced therapies to deliver targeted radiation for precise treatment that spares as much healthy tissue as possible.

Learn More About Radiation Therapy