Adrenal cancers occur when abnormal cells form in or travel to the adrenal glands. There are two adrenal glands, one located above each kidney. Adrenal cancer usually occurs in the outermost layer of the glands, which is called the adrenal cortex. It usually appears as a tumor.
A noncancerous tumor of the adrenal gland that must be differentiated from an adrenal cancer is a benign adenoma. Benign adenomas are relatively small, usually less than 2 inches in diameter. Most people with this type of tumor have no symptoms. These benign tumors usually occur on only one adrenal gland but can sometimes appear on both.
An adrenal cortical carcinoma is a cancerous tumor. These tumors can sometimes produce hormones that cause changes in the body. In some cases they get large enough to start pressing on your organs, causing more symptoms. It is also common for adrenal cortical carcinomas to be much larger than benign adenomas. If a tumor is more than two inches in diameter, it is likely cancerous. If there is cancer in the adrenal glands, but it did not begin there, it is not considered an adrenal cortical carcinoma.
What Causes Adrenal Cancer?
At this point scientists do not know exactly what causes adrenal cancer.
What are the Risk Factors for Adrenal Cancer?
Certain conditions put you at a greater risk for adrenal cancer including:
- Beckwith-Wiedemann syndrome (abnormal growth disorder with large body and organs)
- Li-Fraumeni syndrome (inherited disorder with an increased incidence of cancers)
- familial adenomatous polyposis (inherited condition with many polyps in the large intestines)
- multiple endocrine neoplasia (many tumors, benign or malignant, in glands that produce hormones)
Smoking is also believed to increase the risk of adrenal cancer, but it has yet to be proven conclusively.
Symptoms of Adrenal Cancer
In most cases, symptoms of adrenal cancer are caused by excess production of the hormones androgen and estrogen. Symptoms may also arise from large tumors pressing on organs of the body. Symptoms of excessive hormone production are easier to spot in children than adults because physical changes are more active and visible in puberty. Some signs of adrenal cancer in children are:
- excessive hair growth (pubic, underarm, and facial)
- enlarged penis
- enlarged clitoris
- large breasts in boys
- early puberty in girls
Symptoms of adrenal cancer in adult women are usually harder to detect. They usually do not appear until the tumor is large enough to press on the organs. In men, if the adrenal tumor causes increased estrogen, there may be slight enlargement of the breasts and noticeable tenderness. Women with tumors that cause increases in androgen may notice facial hair growth or deepening of the voice. Some other symptoms are:
- high blood pressure
- weight gain
- irregular periods
- easy bruising
- frequent urination
- muscle cramps
How is Adrenal Cancer Diagnosed?
Diagnosing adrenal cancer usually begins with your medical history and a physical exam. Your doctor will also draw blood and collect a urine sample for testing. Your physician may order further tests such as:
- computed tomography (CT) scan
- positron emission tomography (PET) scan
- magnetic resonance imaging (MRI)
- adrenal angiography
How is Adrenal Cancer Treated
Adrenal cancer can be cured if the treatment is given early on. Some methods of adrenal cancer treatment are as follows:
- Laparoscopic adrenalectomy is done when a surgeon makes small incisions in the abdomen and removes the tumor using a small camera.
- Transabdominal surgery involves a large incision in the abdomen and removal of the tumor. The surgeon will check the surrounding organs for cancer.
- Posterior surgery involves an incision being made in the back for tumor removal.
- Thoracoabdominal surgery is done to remove a particularly large tumor. It involves an incision through the abdomen and chest.
If the tumor has metastasized or spread to other parts of the body, it may be treated with radiation or chemotherapy. For tumors that are too big to be removed safely, cryoablation, or the destruction of tumor cells with freezing, may be performed. Medication like mitotane, which prevents the adrenal glands from producing steroid hormones, may also be prescribed if you have stage II, III, or IV adrenal cancer.
What is the Long-Term Outlook?
Follow-up appointments with your doctor are very important if you have had adrenal tumors. Adrenal cancer can come back at any time. If you took mitotane as part of your treatment, your doctor may prescribe hormones to compensate for the hormone suppression caused by mitotane.