Adrenal cancer
What is adrenal cancer?
Adrenal cancer is a rare cancer in which a malignant tumor forms in one or both adrenal glands from epithelial tissue.
The adrenal glands are endocrine secretion glands located at the upper pole of the kidneys. Adrenal hormones regulate many vital processes in the body. Adrenal cancer develops by malignant transformation of epithelial cells. The tumor can affect the cortical or cerebral layer of the organ.
The diagnosis rate of adrenal cancer is 0.5-2 cases per 1 million population. It is a reasonably rare pathology. The disease is often detected in women 40-50 years old. Children under five years of age are also at risk.
Adrenal tumors are characterized by an asymptomatic course, rapid growth, and propensity to metastasize to the lungs and liver. In most patients, malignant neoplasms with a more than 10 cm diameter are detected. About half of them have tumor invasion into surrounding tissues and metastasis to distant organs.
Types
If the tumor initially formed in the structure of the adrenal gland, we speak of primary cancer. If atypical cells infiltrate the glandular epithelium from other organs, the tumors are considered secondary (metastases). Depending on their ability to produce hormones, tumors are hormonally active and hormonally inactive.
The disease is divided into stages based on the size and extent of the tumor and the presence of metastases in regional lymph nodes and distant organs. The following stages of adrenal cancer development are distinguished:
- First is a tumor up to 5 cm in diameter, localized in the adrenal gland.
- Second, the tumor is more than 5 cm in diameter but is located within the affected adrenal gland.
- Third – the neoplasm is more than 5 mm in diameter, infiltrates into surrounding tissues, or metastasizes to regional lymph nodes.
- Fourth – the malignant process involves the surrounding adrenal structures, regional lymph nodes, and distant organs.
Symptoms
Early stages of adrenal tumors are usually asymptomatic. When the tumor reaches a large size, nonspecific symptoms arise due to the pressure of the tumor on surrounding structures:
- abdominal pain;
- back and lower back pain that may radiate to the sides of the torso;
- frequent urination;
- elevated body temperature;
- instability of blood pressure with a predominance of hypertension;
- muscle spasms;
- apathy or depression;
- menstrual disorders, etc.
Up to 60% of adrenal tumors are hormonally active. Some of them produce cortisol. Chronic increase in the hormone level is accompanied by a redistribution of fatty tissue (thin legs, round abdomen, and fat deposition in the area of the 7th vertebra), skin thinning, sleep disorders, etc.
Other adrenal tumors produce female or male sex hormones. The former is more often detected in young men. It shows symptoms of feminization – characterized by an increase in the tone of voice, lack of hair in typical male areas, testicular atrophy, and fat deposition in the thighs.
Androgen-producing tumors cause accelerated sexual development in children (characterized by coarsening of the voice, hair growth, increased skin oiliness, and acne), baldness in men, and signs of virilization in women (hypotrophy of the mammary glands, lowering the tone of voice, facial hair, loss of hair on the head, etc.).
Reasons
The mechanism of adrenal cancer development is not fully understood. The appearance of the tumor may be due to genetic predisposition. Scientists have established a link between TP53 gene mutations and the risk of adrenal cancer. The provoking factors for the development of adrenal cancer are nonspecific:
- contact with toxic substances;
- bad habits;
- hormonal disorders;
- increase in the general inflammatory background in the body;
- immune dysfunction;
- lumbar trauma;
- malignant tumors of other localization.
Diagnosis
To diagnose adrenal cancer, doctors usually prescribe:
- Ultrasound of the adrenal glands. The procedure allows you to assess the size and structure of the glands, detect neoplasms, and assess their localization, size, density, and degree of vascularization.
- CT or MRI of the adrenal glands with contrast. It allows us to obtain more precise information about the location of the neoplasm and its impact on the surrounding structures. Based on the specifics of contrast agent accumulation, assumptions are made about the possible nature of the tumor.
- Laboratory tests. In addition to general blood tests, tests for hormones (ACTH, DHEA-sulfate, 17-OPH, testosterone, androstenedione, cortisol, etc.) are performed.
Ultrasound, CT, or MRI assesses the condition of regional lymph nodes. Radiography, ultrasonography, CT, and MRI are used to detect metastases in other organs. Based on the information obtained, doctors decide on the possibility of surgery. Biopsy of adrenal tumors is inadvisable due to the high risk of metastases spreading when the tumor capsule is damaged.
Adrenal cancer treatment
In most cases, a combined approach, which combines radical and conservative methods, is used. The first stage of treatment is surgery. Subsequently, chemotherapy, radiotherapy, immune or targeted therapy courses may be prescribed. The treatment program is drawn up on a personal basis, taking into account the stage of disease development, age, and general health of the patient.
Conservative treatment
The following conservative methods are used for adrenal cancer:
- Chemotherapy (before surgery is aimed at reducing the size of the tumor, after – to destroy residual malignant cells);
- Radiation therapy (performed to eliminate atypical cells that may have invaded lymph nodes or surrounding organs, sometimes used as part of palliative treatment);
- Hormonal therapy (aimed at correcting the balance of hormones in the body);
- Symptomatic therapy (performed to reduce the intensity of the symptoms of the disease and relieve the patient’s condition).
Surgical treatment
A radical approach to treatment involves the removal of the tumor together with the gland. The material is sent for histological analysis to verify the diagnosis and selection of further therapy. In cases of advanced cancer, surgery to remove metastases is possible.
All these treatment options are available in more than 790 hospitals worldwide (https://doctor.global/results/diseases/adrenal-cancer). For example, adrenalectomy is performed in 17 clinics across Turkey for an approximate price of $7.2 K (https://doctor.global/results/asia/turkey/all-cities/all-specializations/procedures/adrenalectomy).
Prevention
There are no methods of specific prevention. General preventive measures against cancer imply a healthy lifestyle, regular preventive examinations, avoidance of contact with carcinogenic chemicals, and timely treatment of diseases.
Rehabilitation after surgical treatment
The period of inpatient observation is determined by the scope of the operation and the peculiarities of its performance. After minimally invasive interventions, the patient is discharged on the 2nd-3rd day. After open surgery, hospitalization lasts up to 10 days.
During this period, the patient receives symptomatic treatment and medications to prevent complications and undergoes courses of chemotherapy (if necessary). At the discharge, the doctor gives personalized recommendations regarding the intake of medications, lifestyle, and professional activity. All patients with confirmed cancer should undergo regular check-ups.
