Adrenal Disorders Adrenocortical Cancer

Adrenocortical carcinoma is cancer of the adrenal gland. This rare tumor is potentially curable in the early stages, however, only one-third of tumors remain confined to the adrenal gland at diagnosis. When they metastasize or spread to other parts of the body, these cancers often invade neighboring organs, such as the lungs, liver, or bones. They can also produce symptoms related to the overproduction of hormones, most commonly steroids (see Cushing's Syndrome).

Diagnosis

Some patients with adrenocortical cancer will experience flank or abdominal pain, while others may present with symptoms related to the overproduction of a hormone. The initial workup for suspected adrenocortical cancer begins with a thorough evaluation of blood hormone levels, i.e., cortisol, testosterone, estrogen, and aldosterone followed by a CT or MRI scan. These tests establish whether or not an adrenal tumor is present and if it is producing too much of a certain hormone. The CT or MRI also help demonstrate the location and size of the tumor and can help determine if the tumor is a cancer. If surgery is called for, the scans are also very important for planning the operation.

Treatment

The surgical removal of adrenocortical tumors eliminates any excess hormone production and is potentially curative. In some cases, the tumors can be removed laparoscopically. The decision to use a laparoscopic approach is based on many factors and should be discussed with your surgeon. Most large, invasive tumors require a traditional open incision for the complete removal of the tumor, as well as a safe margin of healthy tissue.

The stage of the cancer is determined by tumor size, the amount of invasion into neighboring organs, and whether there is any spread to the lymph nodes or to distant organs. Patients who have early stage disease, and who have the entire tumor surgically removed, have the best prognosis. Invasion of other organs or spread to the lymph nodes predicts a worse outcome. Patients with metastatic disease may be treated with antihormonal therapy (mitotane) or systemic chemotherapy. Unfortunately, these therapies have limited efficacy.