Adrenal Cancer Overview and Treatment Guide

Adrenal cancer, also called adrenocortical carcinoma, is a rare type of cancer that starts in the adrenal glands. These glands, located on top of each kidney, make hormones that regulate blood pressure, metabolism, immune response and stress. When cancer develops, it can change hormone levels, leading to symptoms such as high blood pressure, weight gain, diabetes, excess facial or body hair, irregular periods or weakness. Because adrenal cancer is uncommon, it can be difficult to diagnose early. In many cases, it is discovered during tests for other health concerns.

Understanding the disease, knowing what to expect and preparing questions for your oncologist are important steps in making informed decisions about treatment.

Receiving a Diagnosis of Adrenal cancer

Diagnosis typically begins with imaging tests such as CT or MRI scans to see the size and spread of the tumor. Blood and urine tests can measure hormones like cortisol, aldosterone or androgens, which are often elevated in adrenal cancer. In some cases, a biopsy is performed to confirm the diagnosis. Doctors may also recommend genetic counseling if there is a family history of adrenal tumors or related cancers.

Because adrenal cancer can mimic other health conditions, it is important to work closely with a care team experienced in rare cancers.

What are Treatment Options for Adrenal Cancer?

Stage 1

Stage 1 adrenal cancer means the tumor is smaller than 5 centimeters and is only within the adrenal gland. At this stage, the cancer has not spread to nearby lymph nodes or other organs, which makes treatment more effective. Many patients diagnosed at this stage have a chance for long-term control or cure.

• Frontline: Surgery (adrenalectomy) to remove the affected adrenal gland is the standard treatment.
• Second line: Mitotane, a drug that suppresses adrenal function, may be recommended if the cancer is likely to return.
• Third line: Radiation therapy can sometimes be used after surgery to lower the risk of recurrence.

Stage 2

Stage 2 cancer is defined as a tumor larger than 5 centimeters but still confined to the adrenal gland. The main difference from stage 1 is size, which can make surgery more complex and raise the risk of spread. However, because it has not moved beyond the gland, it is still considered a localized disease and often treated aggressively with curative intent.

• Frontline: Surgery remains the preferred option.
• Second line: Mitotane or other systemic therapies may follow surgery if doctors believe there is a high risk of recurrence.
• Third line: Clinical trial enrollment is encouraged if additional therapy is needed.

Stage 3

Stage 3 means the tumor has grown into nearby tissues or lymph nodes but has not spread to distant parts of the body. This stage is more challenging to treat, as surgery may not remove all of the cancer. Outcomes can vary depending on how far the tumor has extended, but a combination of therapies is often used.

• Frontline: Surgery, if possible, though tumors may extend into nearby tissue.
• Second line: Mitotane combined with chemotherapy may be used when surgery does not remove all of the cancer.
• Third line: Radiation or targeted therapies available through clinical trials may be considered.

Metastatic Adrenal cancer

Metastatic adrenal cancer means the cancer has spread to distant organs such as the lungs, liver or bones. At this stage, surgery is usually not curative, and treatment focuses on slowing the cancer, reducing symptoms and maintaining quality of life. Clinical trials are especially important, as researchers are studying new targeted drugs and immunotherapies.

• Frontline: Systemic therapy with mitotane, often combined with chemotherapy such as etoposide, doxorubicin and cisplatin.
• Second line: Alternative chemotherapy regimens or targeted drugs in clinical studies.
• Third line: Clinical trial participation, supportive care and symptom management.

What are the Side Effects of Adrenal Cancer Treatment?

Surgery can cause bleeding, infection and changes in hormone balance, sometimes requiring lifelong hormone replacement. Mitotane may lead to fatigue, nausea, diarrhea, confusion and low hormone levels. Chemotherapy can result in hair loss, lowered blood counts, infection risk and digestive problems. Radiation may cause fatigue and irritation of nearby tissues. Your care team can offer medications and supportive care to reduce these side effects.

Next Steps Aftering Being Diagnosed With Adrenal cancer

Adrenal cancer is a rare and complex disease, but effective treatments are available. Surgery offers the best chance for cure when cancer is found early, while medications, chemotherapy and clinical trials provide options for advanced stages. Because treatment can affect hormone production and quality of life, it is important to stay in close communication with your oncologist and care team. Bringing questions to appointments, asking about supportive care services and discussing whether genetic testing or clinical trials are right for you can help guide your journey. Patients and families are encouraged to seek support groups or counseling to navigate the physical and emotional challenges of this diagnosis.

This guide is designed to be a starting point. Your personal experience will be unique. By using this information as a foundation for your discussions, you can partner with your oncologist to make the best decisions for your health.

Editor's note: This article is for informational purposes only and is not a substitute for professional medical advice. Please contact your healthcare team with any questions or concerns.

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