This information represents the views of the doctors and nurses serving on the American Cancer Society's Cancer Information Database Editorial Board. These views are based on their interpretation of studies published in medical journals, as well as their own professional experience.

The treatment information in this document is not official policy of the Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor.

Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask him or her questions about your treatment options.

After the cancer is diagnosed and staged, your doctor will talk to you about your treatment choices. Take time and think about all of the choices. In choosing a treatment plan, factors to think about include your overall health and the stage of the cancer. You might also want get a second opinion. This can give you more information and help you feel good about the choice you make. Another reason to look for a second opinion is that these cancers are rare. Only large cancer centers will have much experience in treating them.

The main methods of treatment for adrenal gland cancer are surgery, radiation therapy, chemotherapy, and the use of other drugs.

Surgery

The goal of surgery is to get out as much of the cancer as possible, no matter where it is found. There are 2 major approaches to removing the adrenal gland. One way is to remove the gland through a cut (incision) in the back, just below the ribs. This works well for small tumors, but it can be hard to see larger tumors well. In the other method, the surgeon makes a cut through the front of the belly. If the cancer has grown into the kidney, it will be removed too. If it has grown into the muscle and fat around the gland, these tissues will also be removed. If the liver is involved, part of that organ will be removed. If the cancer has grown into the large vein that carries blood from the lower part of the body to the heart (called the inferior vena cava), a more involved operation will be needed.

Sometimes adrenal tumors can be removed through a hollow lighted tube called a laparoscope. The main advantage of this method is that because the cuts are much smaller, patients recover from surgery faster. Laparoscopic surgery is often used to treat adenomas, but it may not be an option to treat some larger adrenal cancers. This is because when adrenal cancers have grown into nearby tissues or lymph nodes, it may be hard to remove the whole tumor using laparoscopy.

Radiation therapy

This treatment uses high-energy radiation to kill cancer cells. But radiation therapy is not often used as the main treatment for adrenal cancer because the x-rays do not easily kill this type of cancer. Radiation may be used after surgery to help keep the tumor from coming back (this is called adjuvant therapy). Radiation may also be used to treat areas of cancer spread, such as in the bones or brain.

Chemotherapy

Chemotherapy (often just called chemo) is the use of drugs to kill cancer cells. Usually the drugs are given into a vein or by mouth as a pill. Once the drugs enter the bloodstream, they go throughout the body. Chemo does not cure adrenal cancer. It is most often used for adrenal cancer that has spread or come back after surgery.

The drug most often used for people with adrenal cancer is a drug called mitotane. Mitotane is helpful for people with adrenal carcinomas who are having problems from too much hormones being made. Even when it doesn't shrink the tumor, mitotane can reduce the amount of hormones and relieve symptoms. But this drug can cause major side effects. The most common are nausea, vomiting, diarrhea, rashes, and sleepiness. Sometimes lower doses of the drug can still work well while causing fewer side effects.

Giving mitotane after the cancer is removed may help keep the cancer from growing back. This is called adjuvant chemotherapy. It works well for other types of cancer, but has not been studied well in adrenal cortex cancer.

There are other chemo drugs that can be used to treat adrenal cancer, too. Chemo can cause side effects. The side effects depend on the type of drugs given, the amount taken, and how long the treatment lasts. Side effects could include the following:

• nausea and vomiting
• loss of appetite
• hair loss (hair grows back after treatment)
• hand and foot rashes
• mouth sores
• increased chance of infection (from low white blood cell counts)
• bleeding or bruising easily (from a shortage of blood platelets)
• tiredness (from low red blood cell counts)

If you have side effects, your doctor or nurse can suggest steps to ease them. For example, there are drugs to help control and prevent nausea and vomiting. The good news is that most side effects go away over time when your treatment ends.

Other drugs to treat adrenal cancer

Other drugs besides mitotane may be used to block hormone production by the cancer. These can help relieve symptoms caused by these hormones, but they don't cause the cancer to shrink.

Last Medical Review: 11/04/2009
Last Revised: 11/04/2009