Adrenal Cancer - Causes, Symptoms, Diagnosis, and Treatment

What is Adrenal Cancer?

Adrenal glands are the two triangular glands above the kidneys, located deep inside the upper part of the abdomen. The adrenal gland is an exocrine gland that secretes hormones and gives instructions to all the organs and tissues in the body. Adrenal cancer, also called adrenocortical cancer, can occur at any age, most probably in children under five and adults during their 40s and 50s. The cure rate is high when it is diagnosed at an early stage.

What Can Cause Adrenal Cancer?

There is no exact cause for adrenal cancer. Adrenal cancer can occur when there is a mutation in the DNA of the adrenal gland cells. Usually, the DNA in the cell instructs the cell on what to do. This type of DNA transformation can instruct the cell to multiply uncontrollably. In this process, the healthy cells turn into abnormal cells, forming a tumor. This tumor can also spread to other parts of the body through metastasis.

What Are the Signs and Symptoms of Adrenal Cancer?

• High blood pressure.

• Heart palpitations.

• Nervousness.

• Abdominal pain.

• Low potassium level.

• Headache.

• Excessive perspiration.

• Feelings of anxiety or panic attacks.

• Diabetes.

• Excessive hair growth.

• Weakness.

• Unexplained weight gain or weight loss.

• Changes in genitalia.

• Change in libido (sex drive).

• Abdominal stretch marks.

• Unusual acne.

What Are the Risk Factors for Adrenal Cancer?

The people who are at risk of developing adrenal cancer are:

• Children who are less than five years of age.

• Adults in their 40's and 50's.

• Smokers.

• People who are exposed to carcinogens.

• Genetic syndromes like Li-Fraumeni syndrome, Von Hippel-Lindau disease, Beckwith-Wiedemann syndrome, and multiple endocrine neoplasia type 1 and 2 (MEN1, MEN2).

What Are the Stages of Adrenal Cancer?

The stages are

• Stage 1:

If the tumor is five centimeters or less and has not spread out of the adrenal gland.

• Stage 2:

If the tumor is over five centimeters but has not spread out of the adrenal gland.

• Stage 3:

The cancer is present in the adrenal gland and also spreads to the nearby lymph node.

• Stage 4:

The cancer is present in the adrenal gland and has also spread to other parts of the body, such as the lungs and liver.

What Are the Types of Adrenal Cancer?

1. Adrenocortical carcinoma is also called adrenal cortex cancer or adrenal cortical carcinoma (ACC), which is the most common form of adrenal cancer. It usually forms in the cortex's outer layer. It is only detected once the tumor becomes very large. This type of cancer is often discovered after the onset of pain, symptoms, or a feeling of fullness, which results in weight loss. Adrenocortical carcinomas produce excess hormones that may cause excess facial hair, weight gain, or early puberty. Adrenal tumors bigger than 5 to 6 centimeters are considered to be cancer.

2. Pheochromocytoma: This type of adrenal cancer is usually formed in the medulla's central part and typically begins in adrenaline-producing cells. Adrenaline helps to regulate essential bodily functions, including blood pressure and heart rate regulation. Elevated blood pressure, racing heart, excessive sweating, and anxiety are the symptoms of this type of tumor.

3. Neuroblastoma: These tumors are found in the developing nerve cells of the medulla. This type of adrenal cancer usually affects children or infants under the age of 10. Early detection is possible due to the unique nature of the cells. However, the source may be hard to define in some cases since the cells can spread quickly. According to the American Cancer Society, about one in three neuroblastomas usually begin in the adrenal glands.

How Is Adrenal Cancer Diagnosed?

• Blood and Urine Tests: These tests help measure the number of adrenal hormones and are used to detect a functional tumor. The doctor needs a 24-hour urine sample. This test requires a person to collect urine for 24 hours for laboratory testing. The test results will help the doctor to track quickly various hormones are produced. One specific hormone the doctors look for in these tests is the cortisol stress hormone, and a particular test, called a dexamethasone-suppression test, helps check cortisol levels. The patient may be asked to take a pill the previous evening for this test. This pill acts like cortisol in the body. When people who do not have an adrenal gland tumor take this drug, their bodies will make less cortisol and other hormones. However, if the person has an adrenal gland tumor, cortisol levels will continue to be high even after taking the drug. Inform your doctor about any medications you take, even over-the-counter medicines, herbal pills, or vitamins, because this information is needed to interpret the results correctly.

• Biopsy: A small amount of tissue is removed for examination under a microscope. If the doctor assumes that cancer has spread from another part of the body to the adrenal gland, a biopsy may be required to determine from where cancer began, helping the doctor with a treatment plan. A narrow, hollow needle is inserted to collect the tissue in a biopsy. This is called a fine-needle aspiration biopsy. A radiologist performs the biopsy along with specialized imaging procedures, such as CT scans, to guide the needle to be inserted directly into the tumor. A pathologist then investigates the sample removed during the biopsy.

• CT (computed tomography) or CAT scan: A CT scan is a 3-dimensional picture of the internal body parts using X-rays taken from different angles. A computer will combine these images into a comprehensive, cross-sectional view showing tumors or abnormalities. A special dye, a contrast medium, is given before the scan to detail the image. This dye is injected into the patient's vein through a peripheral intravenous (IV) line, and a short, plastic tube is inserted into the vein to help the healthcare team give fluids or medication.

• MRI (magnetic resonance imaging): An MRI uses magnetic fields, not X-rays, to measure the tumor's size. To create a clearer picture, a special dye called a contrast medium is given to the patient before the scan. This dye is injected into a patient's vein or given in pill form to swallow.

• Metaiodobenzylguanidine (MIBG) Scan.

• Adrenal Vein Sampling (AVS).

How to Treat Adrenal Cancer?

• Surgery:

Surgery can be used to treat all stages of cancer of the adrenal gland.

• Chemotherapy:

In some advanced adrenal cancer cases, chemotherapy may be used in combination with surgery to destroy cancer cells or keep them from spreading and growing.

• Radiation Therapy:

Radiation therapy is used to shrink or destroy cancer cells not removed through surgery. It is often recommended after surgery for patients with advanced adrenal cancer.

Does adrenal cancer spread fast?

This depends on the type of tumor:

• Adrenocortical carcinoma is the standard type that spreads rapidly.

• Few neuroblastomas can spread quickly, while others grow slowly.

Conclusion

Adrenal cancer is a rare type of neuroendocrine tumor. This condition occurs when cells present in the adrenal gland mutate. This condition is difficult to cure. However, this condition can be treated if diagnosed at an early stage. Treatment plans include radiation therapy, surgery, and chemotherapy.