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Stages I and II
Surgery is the main treatment for stage I and stage II adrenal
cortical carcinoma. The entire adrenal gland will be removed. Since
there are 2 adrenal glands, removal of the diseased one does not cause
problems for the patient. If nearby lymph nodes are enlarged, they will
be removed as well. Most surgeons do not remove these lymph nodes if
their size is normal. If the cancer is not producing hormones, no
further treatment may be necessary. However, there will be periodic
follow-up examinations since even stage I cancers can come back.
Another option is to give radiation or mitotane after surgery to help
keep the cancer from coming back.
Stage III
Surgery is also the main treatment for stage III adrenal
cortical cancer. The goal of surgery is to remove all of the cancer.
The adrenal gland containing the tumor is always removed, and the
surgeon might also need to remove some tissue around the adrenal,
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,
treatment with radiation 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. Still, 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 people with painful bone
metastases. Mitotane therapy may begin at the time of surgery or the
doctors may wait until there are symptoms. Other chemotherapy drugs may
also be used.
Recurrent adrenal cortical carcinoma
Cancer is called recurrent when it come backs after treatment.
Recurrence can be local (in or near the same place it started) or
distant (spread to organs such as the lungs or bone). Recurrent adrenal
cortical cancer is treated like stage IV disease. Surgery may be done
to relieve symptoms. People with recurrent disease are often treated
with mitotane. They may also receive chemotherapy and/or radiation
therapy. If the mitotane doesn't work or cannot be tolerated, other
drugs can be given to lower hormone production.
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 drugs to treat pain are morphine and other narcotic drugs.
Many studies have shown that taking morphine 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.
Last Medical Review: 03/20/2009
Last Revised: 03/20/2009
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