Adrenal Cortical Cancer Overview

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Early Detection, Diagnosis, and Staging TOPICS

How is adrenal cancer found?

It is hard to find adrenal cancer early. In most cases the tumor has grown quite large before it is found. It is often found earlier in children than in adults because children react more to the hormones these tumors make. In adults, these tumors may be found early by accident, for example when a CT scan is done for some other health problem.

The symptoms of adrenal cancer can be caused by either the hormones they make or because the tumor has grown large and is pressing on nearby organs. If you or your child has any of the symptoms below, see a doctor right away. Getting the right tests is the only way to find out for sure what is causing the symptoms.

Signs and symptoms of adrenal cancer

In about half of people with adrenal cortex cancer, symptoms are caused by the hormones made by the tumor. In the other half, symptoms occur because the tumor has grown so large that it presses on nearby organs.

Symptoms caused by the hormones androgen or estrogen

In children, symptoms are most often caused by male-type hormones (androgens) that the tumor makes. These symptoms include:

  • Excess growth of facial, pubic, and underarm hair
  • Enlargement of the penis (boys)
  • Enlargement of the clitoris (girls)

A different set of symptoms can happen if the tumor makes female-type hormones (estrogens). These include:

  • Early puberty in girls (having periods and the breasts getting larger)
  • Breasts getting larger (boys)

In adults, the symptoms from sex hormones are harder to spot because these changes have already taken place. Women with tumors that make estrogen often do not have any symptoms unless the tumor is large enough to press on nearby organs.

Symptoms are easier to notice if the tumor is making the hormone that is not usually there. For instance, men with tumors that make estrogen may have slight breast tenderness and enlargement. They may also notice less sex drive and trouble getting an erection. Women with tumors that make androgens may notice the growth of excess facial and body hair, irregular periods, and deepening of their voice.

Symptoms caused by high levels of cortisol

There is a group of symptoms called Cushing syndrome that are caused by high levels of a hormone called cortisol (or hormones like it). Some of the symptoms of Cushing syndrome include:

  • Weight gain, often around the chest and stomach
  • Fat deposits behind the neck and shoulders
  • Purple stretch marks on the stomach
  • Hair growth on the face, chest, and back in women
  • Irregular periods
  • Weakness in the legs
  • Easy bruising
  • Depression or moodiness
  • Weak bones which can lead to broken bones
  • High blood sugar, often leading to diabetes
  • High blood pressure

There are several reasons a person may have high cortisol levels. Your doctor will need to do some tests to find out if the symptoms are from adrenal cancer or something else.

Symptoms caused by high aldosterone levels

If the tumor makes a hormone called aldosterone, the main symptoms include:

  • High blood pressure
  • Weakness
  • Muscle cramps
  • Increased thirst
  • Urinating very often

In most cases, aldosterone is made by a benign adenoma rather than by cancer.

Symptoms caused by a large adrenal cancer pressing on nearby organs

If the tumor is large and presses on nearby organs and tissues it can cause pain, a feeling of fullness in the belly, or trouble eating because the stomach feels full quickly.

If you have any of the signs or symptoms above, talk to a doctor right away. Remember, the sooner your cancer is found, the sooner you can start treatment. And the earlier you get treatment, the better it will work.

Medical history and physical exam

If there is any reason to think you might have cancer, the first step will be a complete medical history and physical exam. Your doctor will want to know if anyone in your family has had adrenal cancer. You'll also be asked about your periods or other sexual issues and what symptoms you have had.

Imaging tests

Imaging tests are ways to take pictures of your insides. One or more of these tests may be done if the doctor thinks you may have adrenal cancer.

Chest x-ray: This can show if the cancer has spread to the lungs. It may also help to see if you have any lung or heart diseases.

Ultrasound: This test uses sound waves to make pictures of your insides. A computer shows the picture on a screen. This test can show if there is a tumor (mass) in the adrenal gland. It can also show if there is a tumor in the liver. Most likely it won't be used unless a CT scan can't be done.

CT scans (computed tomography): A CT scan uses x-rays to make detailed pictures of your insides. Instead of taking just 1 x-ray, a CT scanner takes many pictures as it moves around you. A computer then combines these into a picture of a slice of your body. CT scans can show the adrenal glands and can often confirm whether a tumor is present, how large it is, and whether it has spread to nearby sites. CT scans also show the organs near the adrenal glands, as well as lymph nodes and distant organs. This test can help show if the cancer has spread to the liver or other organs. It also may be used to guide a needle into an area of concern. Once the needle is in, a piece of tissue is removed to be looked at under a microscope. This is called a CT-guided needle biopsy.

Before any pictures are taken, you may be asked to drink some liquid called oral contrast. This helps outline the intestine so that certain areas are not mistaken for tumors. You may also get an IV (intravenous) line through which you get a contrast dye. This helps better outline structures in your body.

The contrast dye can cause some redness and a warm feeling that may last hours to days. A few people are allergic to the dye and get hives. Rarely, more serious reactions like trouble breathing and low blood pressure can happen. Medicine can be given to prevent and treat these problems. Be sure to tell the doctor if you have ever had a reaction to any contrast substance used for x-rays.

CT scans take longer than regular x-rays and you need to lie still on a table while they are being done. Also, you might feel a bit confined by the large ring the table slides through while the scan is being done.

PET scan (positron emission tomography): For a PET scan, a type of radioactive sugar is put into your vein. The sugar collects in cancer cells. A scanner can spot these areas. This test is useful for finding cancer that has spread beyond the adrenal glands. It is also helpful in finding adrenal cortex cancer that has spread outside of the adrenal glands.

MRI (magnetic resonance imaging): MRI scans use radio waves and strong magnets instead of x-rays to take pictures. MRI pictures look a lot like those of a CT scan, but MRIs are more detailed. An MRI scan can also show views from different angles. The MRI sometimes gives more information than a CT scan because it can better show the difference between adrenal cancer and a benign adenoma. An MRI is especially helpful in looking at the brain and spinal cord.

MRIs are a little more uncomfortable than CT scans. First, they often take up to an hour. Also, you must lie still inside a narrow tube, which may be upsetting to some people. If you have problems with tight spaces, tell the doctor before your MRI is set up; you may be able to have the test done using an open MRI scanner. The machine makes a thumping and clicking noises as the magnet switches on and off. Some places have earplugs or headphones with music to block this out.

Other tests

Laparoscopy: The doctor may do this test in order to get ready for surgery. The laparoscope is a thin, flexible tube with a tiny video camera on the end. It is put into the body through a small cut in the patient's side to allow the surgeon to see where the cancer is growing. It can be used to make sure all the cancer can be removed. Sometimes surgeons can remove small tumors through this tool. (This is described in the section, "Surgery.")

Biopsy: In a biopsy a sample of tissue is removed to see whether cancer cells are in it. This test may be done before surgery by using a needle that takes out small pieces of tissue. A CT scan or ultrasound might be used to help guide the needle. The results can show whether the tumor started in the adrenal cortex, the medulla, or some other part of the body. But it might not show whether the tumor is cancer or not. For this reason, surgery is done if the tumor's size and certain features suggest it is cancer. If it looks as if the cancer has spread to another part of the body, such as the liver, then a biopsy may be done in those places, too.

Blood and urine tests: These tests are important in deciding whether a patient with symptoms of adrenal cancer has the disease. Doctors choose which tests to do based on the patient's symptoms. Because they know which symptoms are linked with high levels of certain hormones, they can select the right test for the patient.

Last Medical Review: 04/22/2010
Last Revised: 06/22/2010