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Adrenal Cancer Overview
The adrenal glands are small glands located above each kidney. They produce mineralocorticoids, glucocorticoids, epinephrine and norepinephrine as well as sex hormones. There are two parts of the adrenal gland, the medulla and the cortex. Cancers can occur in either part of the adrenal gland.
Cancer occurs in the adrenal gland when cells grow out of control and do not stop growing when necessary. Cancer cells can break off and travel to other body areas. They travel through the lymphatic system or through the bloodstream. This is called a metastasis. Most adrenal tumors are benign, such as a pheochromocytoma of the adrenal medulla. In fact, most adrenal cancers are metastatic from other body areas. If the adrenal cancer spreads to other body areas, they tend to go to the liver, lungs and bone.
Adrenal cortical cancers begin in the adrenal cortex and may secrete excess steroid hormones or may be inactive (not secreting hormones). Functioning adrenal tumors are more common than non-secreting tumors. The most common adrenal medullary tumor is a pheochromocytoma. Neuroblastomas can occur in the adrenal glands in children.
The signs and symptoms of adrenal cancers usually relate to the overproduction of steroid hormones or other hormones. There can be a condition called Conn's syndrome, which is primary hyperaldosteronism. This causes high blood pressure, decreased potassium in the bloodstream and decreased blood renin levels.
Cushing's syndrome is another problem that can occur in adrenal cancer. This involves an elevation of glucocorticoids in the bloodstream, which results in weight gain, fluid retention, emotional disorders, round face and a buffalo hump in the upper back. There can be stretch marks and excessive hair growth. It may be due to a cancer of the adrenal gland or to a benign tumor of the adrenal gland. Sex hormones can result in too much testosterone in the system and Virilization of the body. Feminization can occur in men who have too much female hormone in the body.
Only about five hundred cases of adrenal cortical cancers occur in the US each year. They most commonly affect those between the ages of 30 and 50. It can occur in children as well. There is no known cause of adrenal cancers with the exception of possible genetic factors.
The diagnosis of adrenal cortical cancers and adenomas are usually found because of secondary Cushing's syndrome or from sex hormone production. The amount of cortisol in the system is assessed by checking a urine cortisol level over twenty four hours. A dexamethasone suppression test is done to see if the body responds in a specific way. Normally, the body will suppress its production of cortisol in the presence of dexamethasone but, in cancerous conditions, this will not happen. Renin levels are lowered in hyperaldosteronism secondary to an aldosterone-producing tumor. CT scans or MRI scans can look directly at the adrenal glands for tumors present on or in the glands. An ultrasound of the tumor can show the size and shape of the tumor on the adrenal gland.
A biopsy of the adrenal gland cancer is the only way to see really what is going on. This can be done through a needle biopsy or through a laparoscopic or open biopsy. A needle biopsy under ultrasound guidance is the least invasive way to get a biopsy report.
Adrenal cancer can be staged. Stage I adrenal cancer is less than 5 cm in diameter and has not spread. Stage II adrenal cancer is bigger than 5 cm in diameter and has not spread. Stage III cancer has spread to the fatty tissue around the adrenal gland. Stage IV cancer has spread metastatically to other body areas.
The treatment of adrenal cancer involves surgery to remove the cancerous tissue. Chemotherapy is sometimes done and radiation to remove residual cancer can be done in rare cases.
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The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here