(Cancer of the Adrenal Cortex; Adrenal Cortical Carcinoma; Adrenal Cancer)
The adrenal glands are two glands located just above each kidney. The glands produce important hormones. These hormones regulate heart rate, blood pressure, and many other vital functions. The adrenal cortex is the outside layer of the two adrenal glands.
Cancers of the adrenal cortex are very rare. They make up 0.5-2 cases per million. The majority of these tumors produce excess hormones. The excess can alter hormonal balance.
Anatomy of the Adrenal Glands
There are few known risk factors for cancers of the adrenal cortex but, the following factors may contribute:
- Being female
- Children under 5 years old
- Adults between 40 to 50 years old
- A genetic defect may cause adrenocortical cancer in some children, but the majority are non-hereditary
Approximately 40% of adrenocortical carcinoma do not secrete any hormone. These do not have any specific symptoms. They are discovered either by accident or as part of an evaluation of abdominal pain.
Other tumors are functional. This means are hormonally active. Excess hormones may produce symptoms such as:
- ]]>Cushing’s syndrome]]> (Hypercortisolism)—30% of cases—excess cortisol which helps the body respond to stressful situations and infections
- Conn’s syndrome (Hyperaldosteronism)—2% of cases—excess aldosterone, which helps the body maintain normal levels of sodium and potassium
- Virilization (20% of cases)—women with functional tumors that release males hormones; may deepen voice, cause ]]>hirsutism (growing excess hair on the face)]]> , and swelling of the sex organs or breasts may occur
- A mixed Cushing’s syndrome and virilization accounts for 35% of all cases
- In young children with functional tumors that release sex hormones, these tumors may cause early onset of puberty
These symptoms may be caused by other health conditions. Anyone experiencing these symptoms should see a doctor.
Your doctor will ask about your symptoms, and medical and family history. A physical exam will be done.
Tests may include the following:
- Blood tests to look for hormones from the adrenal glands
- Urine tests (24 hour cortisol)
- CT scan of the abdomen]]> —a type of x-ray that uses a computer to make pictures of structures inside the abdomen
- ]]>MRI of the abdomen]]> —a test that uses magnetic waves to make pictures of structures inside the abdomen
- PET scan—a test that uses radioactive glucose to identify the location of tumors in the body
- Adrenal angiography and/or venography—tests that use contrast dye to help confirm the presence of tumors that may be blocking blood vessels; a blood sample may be obtained to check hormone levels
- ]]>X-ray]]> —a test that uses radiation to take a picture of structures inside the body
Once cancer of the adrenal cortex is confirmed, you will be referred to an oncologist. This type of doctor focuses on cancer.
Further testing to determine what stage (1-4) the cancer has reached. The stage of a tumor is determined by its size and how far it has spread from its point of origin. At the time of diagnosis, 30%-85% of patients are found to have cancer that has spread. The higher the stage, the more dangerous and difficult it is to treat.
Treatment depends on the stage of the tumor and your overall health. Talk with your doctor about the best plan for you.
The following methods are used to treat cancer of the adrenal cortex:
Adrenalectomy]]> Surgery to Remove the Tumor
Surgery to remove the adrenal tumor. This is the first treatment approach for about 75 % of all cases. The doctor will also need to remove any surrounding tissues or lymph nodes that contains cancer cells.
]]>Radiation therapy]]> and ]]>Chemotherapy]]>
These treatments tend to be less effective in treating this type of cancer. They are most often used if the cancer has spread. Chemotherapy may also be used if there is a high chance the cancer will come back.
—is the drug most often used for this type of cancer. It blocks hormone production by the adrenal gland. It also destroys adrenal cancer cells. This drug does have serious side effects.
- Especially helpful in treating functional tumors of the adrenal cortex
- Other hormone blocking drugs may be given if mitotane does not work.
- Research of new drug and radiation therapies are under way. This includes gene and immunotherapy. Your doctor may advise you to participate in one of these trials.
If treatment is successful you will still need to be screened for reoccurrence of the cancer on a periodic basis.
American Cancer Society
National Cancer Institute
BC Cancer Agency
Canadian Cancer Society
Abiven G, Coste J, Groussin L, et al. Clinical and biological features in the prognosis of adrenocortical cancer: poor outcome of cortisol-secreting tumors in a series of 202 consecutive patients. J Clin Endo & Metab . 2006;91:2650-55.
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Adrenocortical carcinoma. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/types/adrenocortical . Accessed November 30, 2006.
Adrenocortical carcinoma: treatment statement for health professionals. National Cancer Institute website. Available at: http://www.meb.uni-bonn.de/cancer.gov/CDR0000062907.html . Accessed Nov. 30, 2006.
Allolio B, Fassnacht M. Adrencortical carcinoma: clinical update. J Clin Endocrinol Metab .2006;91:2027-37.
Detailed guide: adrenal cortical cancer. American Cancer Society website. Available at: http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?dt=71 . Accessed November 29, 2006.
Kirschner LS. Review: emerging treatment strategies for adrnocortical carcinoma: a new hope. J Clin Endocinol Metab .2006;91:14-21.
Van Ditzhuijsen cI, van de Weijer R, Haak HR: Adrenocortical carcinoma. Neth J Med. 2007;65:55-60.
Last reviewed January 2009 by ]]>Rosalyn Carson-DeW¹itt, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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