How Is Adrenal Cancer Diagnosed?
Medical history and physical exam
The first step is for the doctor to take your complete medical history to check for any symptoms. Your doctor will want to know if anyone in your family has had adrenal cancer or any other type of cancer. Your doctor will also ask about your menstrual or sexual function and about any other symptoms that you may be having. A physical exam will give other information about signs of adrenal gland cancer and other health problems. Your doctor will thoroughly examine your abdomen for evidence of a tumor (or mass).
Your blood and urine will be tested to look for high levels of the hormones produced by some adrenal adenomas and carcinomas. If an adrenal tumor or cancer is suspected, imaging tests will be done to look for a tumor. These tests can also help see if it has spread.
If a mass is seen on an imaging test and it is likely to be an adrenal cancer, doctors will recommend surgery to remove the cancer. Generally, doctors do not recommend a biopsy (removing a sample of the tumor to look at under the microscope to see if it is cancer) before surgery to remove the tumor. That is because doing a biopsy can increase the risk that an adrenal cancer will spread outside of the adrenal gland.
A chest x-ray can show if the cancer has spread to the lungs. It may also be useful to determine if there are any serious lung or heart diseases.
Ultrasound tests use sound waves to take pictures of parts of the body. A device called a transducer produces the sound waves, which are reflected by tissues of nearby organs. The pattern of sound wave echoes is detected by the transducer and analyzed by a computer to create an image of these tissues and organs. This test can show if there is a tumor mass in the adrenal gland. It can also diagnose tumor masses in the liver if the cancer has spread there. In general, it is not used to look for adrenal tumors unless a CT scan isn’t able to be done.
Computed tomography (CT)
CT scans show the adrenal glands fairly clearly and often can confirm the location of the cancer. It can also help show whether your cancer has spread into your liver or other organs nearby. CT scans can also show lymph nodes and distant organs where metastatic cancer might be present. The CT scan can help determine if surgery is a good treatment option.
The CT scan is an x-ray procedure that produces detailed cross-sectional images of your body. CT scans take longer than regular x-rays. Instead of taking one picture, like a conventional x-ray, a CT scanner takes many pictures as the camera rotates around you. A computer then combines these pictures into an image of a slice of your body. The machine will take pictures of many slices of the part of your body that is being studied.
Positron emission tomography (PET)
In PET, radioactive glucose (sugar) is injected into the patient’s vein. Because cancer cells use sugar much faster than normal tissues, radioactivity will tend to concentrate in the cancer. A scanner can spot the radioactive deposits. This test can be helpful in spotting small collections of cancer cells and may be used to find cancer that has spread. It also may help in deciding if an adrenal tumor is likely to be benign or malignant (cancer).
Magnetic resonance imaging (MRI)
MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of tissue and by certain diseases. A computer translates the pattern of radio waves given off by the tissues into a very detailed image of parts of the body. Not only does this produce cross sectional slices of the body like a CT scanner, it can also produce slices that are parallel with the length of your body. For some MRI scans, a contrast material called gadolinium is injected into a vein (IV). MRI may sometimes provide more information than CT scans because it can better distinguish adrenal cancers from benign tumors.
MRI scans are particularly helpful in examining the brain and spinal cord. In people with suspected adrenal tumors, an MRI of the brain may be done to examine the pituitary gland. Tumors of the pituitary gland, which lies underneath the front of the brain, can cause symptoms and signs similar to adrenal tumors.
This procedure uses a laparoscope, a thin, flexible tube with a tiny video camera on the end. It is inserted through a small surgical opening in the patient's side to allow the surgeon to see where the cancer is growing. It can spot distant spread as well as enlarged lymph nodes. Sometimes it is combined with ultrasound to give a better picture of the cancer. Laparoscopy may be done to help predict whether it will be possible to completely remove the cancer by surgery. In addition to viewing adrenal tumors through the laparoscope, surgeons can sometimes remove small benign adrenal tumors through this instrument. This method is described in the section, “ Surgery for adrenal cancer.”
Imaging tests may find tumors, but often the only way to know for sure that a tumor is cancer is to remove a sample of tumor tissue to look at under the microscope. This is called a biopsy. If a thin needle that only removes tiny bits of tissue is used, it is called a fine needle aspiration, or FNA. When a larger needle that removes a thin cylindrical core of tissue is used, it is called a core needle biopsy. In either case, the biopsy is often done using a CT scan or ultrasound to guide the tip of the needle into the tumor.
Since adrenal adenomas and cancers can look alike under the microscope, a biopsy may not be able to tell whether or not an adrenal tumor is cancerous. Also, a needle biopsy of an adrenal cancer can actually spread tumor cells. For these reasons, a biopsy is generally not done before surgery if an adrenal tumor's size and certain features seen on imaging tests suggest it is cancer. A work-up with blood tests for hormone production and imaging studies are more useful than biopsies in the diagnosis of adrenal cancer.
If the cancer appears to have metastasized (spread) to another part of the body such as the liver, then a needle biopsy of the metastasis may be done. If a patient is known to have an adrenal tumor and a liver biopsy shows adrenal cells are present in the liver, then the tumor is cancer.
In general, a biopsy is only obtained in a patient with adrenal cancer when there are tumors outside the adrenals and the doctor needs to know if these are spread (metastases) from an adrenal cancer or are caused by some other cancer or disease. Adrenal tumors are sometimes biopsied when the patient is known to have a different type of cancer (like lung cancer) and knowing that it has spread to the adrenal glands would alter treatment.
Tests for adrenal hormones
Blood and urine tests to measure levels of adrenal hormones are important in deciding whether a patient with signs and symptoms of adrenal cancer has the disease. For urine tests, you may be asked to collect all of your urine for 24 hours. Blood and urine tests are as important as imaging tests in diagnosing adrenal cancer. Doctors choose which tests to do based on the patient's symptoms. Doctors know which symptoms are associated with high levels of certain hormones, so they can focus on ways to look for the hormones most likely to be affected. Often doctors will check hormone levels even when symptoms of high hormone levels are not present. This is because symptoms of abnormal hormone levels can be very subtle and blood tests may even be able to detect changes in hormone levels before symptoms occur.
Tests for high cortisol levels
The levels of cortisol are measured in the blood and in the urine. If an adrenal tumor is making cortisol, these levels will be abnormally high. These tests may be done after giving the patient a dose of dexamethasone. Dexamethasone is a drug that acts like cortisol. If given to someone who does not have an adrenal tumor, it will decrease production of cortisol and similar hormones. In someone with an adrenal cortex tumor, these hormone levels will remain high after they receive dexamethasone. Blood levels of ACTH will also be measured to help distinguish adrenal tumors from other diseases that can cause high cortisol levels.
Tests for high aldosterone levels
The level of aldosterone will be measured and will be high if the tumor is making aldosterone. Also, high aldosterone leads to low levels of potassium and renin (a hormone produced by the kidneys) in their blood.
Tests for high androgen or estrogen levels
Patients with androgen-producing tumors will have high levels of dehydroepiandrosterone sulfate (DHEAS) or testosterone. Patients with estrogen-producing tumors will have high levels of estrogen in their blood.
Last Medical Review: March 19, 2014 Last Revised: February 25, 2015