Treatment Choices by Stage of Adrenal Cancer

Treatment of adrenal cancer depends to a large degree on where the cancer started and how far it has spread.

Stages I and II

Surgery is the main treatment for stage I and stage II adrenal cancer. The entire adrenal gland will be removed. Since a person has 2 adrenal glands, removal of the diseased one does not generally cause problems for the patient. If nearby lymph nodes are enlarged, they will be removed as well and checked to see if they contain cancer cells. Most surgeons do not remove these lymph nodes if they're not enlarged.

In many cases, no further treatment is necessary. If the tumor was not removed completely, treatment with radiation and/or mitotane may be given after surgery to help keep the cancer from coming back.

These treatments may also be given if the tumor has a higher chance of coming back later because it was large or appears to be growing quickly (when looked at with a microscope). When treatment is given after surgery has removed all visible cancer, it is called adjuvant therapy. The goal of adjuvant therapy is to kill any cancer cells that may have been left behind but are too small to be seen. Killing these cells lowers the chance of the cancer coming back later.

Stage III

Surgery is the main treatment for stage III adrenal cancer. The goal of surgery is to remove all of the cancer. The adrenal gland with the tumor is always removed, and the surgeon might also need to remove some tissue around the adrenal gland, including part (or all) of the nearby kidney and part of the liver. The lymph nodes near the adrenal gland will also be removed. After surgery, adjuvant treatment with radiation and/or mitotane may be given to help keep the cancer from coming back.

Stage IV

If it is possible to remove all of the cancer, then surgery may be done. When the cancer has spread to other parts of the body, it usually cannot be cured with surgery. Some doctors may still recommend surgery to remove as much of the tumor as possible. This type of surgery is called debulking. Removing most of the cancer may help reduce symptoms by lowering the production of hormones. Radiation therapy may also be used to treat any areas of cancer that are causing symptoms. For example, radiation can help when cancer that has spread to the bones is causing pain. Mitotane therapy is also an option. Treatment may begin right away, or it may be postponed until the cancer is causing symptoms. Other chemotherapy (chemo) drugs may also be used.

Recurrent adrenal cancer

Cancer is called recurrent when it comes back after treatment. Recurrence can be local (in or near the same place it started) or distant (in other organs such as the lungs or bones). Local recurrence may be treated with surgery to remove the cancer. This is more likely to be done if all of the cancer can be removed. Distant recurrence is treated like stage IV disease. Debulking (removing as much of the cancer as possible) surgery may be done to relieve symptoms. People with recurrent disease are often treated with mitotane and/or other chemo drugs. They may also receive radiation therapy. If the mitotane doesn't work or cannot be tolerated, other drugs can be given to lower hormone production. For more information on recurrence, see Understanding Recurrence.

Most of the time, these treatments provide only temporary help because the tumor will eventually continue to grow. When this happens and these treatments are no longer helping, treatment aimed at providing as good a quality of life as possible may be the best choice. The best medicines to treat pain are morphine and other opioids. Many studies have shown that taking morphine as directed for pain does not mean a person will become addicted.

There are many other ways your doctor can help maintain your quality of life and control your symptoms. This means that you must tell your doctor how you are feeling and what symptoms you are having. Many patients don't like to disappoint their doctors by telling them they are not feeling well. This does no one any good.