Adrenal Cancer

Treatment

The following treatment options are available to patients at Mayo Clinic. Treatment decisions are based on each patient's unique condition.

Surgery

For tumors confined to the adrenal gland, Mayo Clinic physicians usually recommend surgery. In the early stages of growth an adrenal cancer may not produce noticeable symptoms. Patients often do not seek medical attention until symptoms become bothersome due to the tumor's growth. Excess hormones produced by the tumor may also cause symptoms. Mayo Clinic surgeons perform four types of surgery to remove benign and malignant adrenal tumors: transabdominal, thoracoabdominal, or posterior surgery, or laparoscopic adrenalectomy.

In transabdominal surgery, the surgeon makes an incision in the patient's abdomen, which allows the surgeon to check nearby blood vessels and organs for cancer. It also allows the surgeon to remove nearby tissue directly involved with the tumor.

Thoracoabdominal surgery requires a large incision and may be used for very large, malignant adrenal tumors. It provides a broad view of the tissue surrounding the tumor, which may contain cancer cells.

Posterior surgery involves an incision in the patient's mid-back above the kidneys, and is used for small, benign tumors. Recovery from surgery using a posterior approach is often easier than recovery from other procedures. This approach is not used with confirmed or suspected malignancies because exposure is limited.

In a laparoscopic adrenalectomy, the surgeon inserts a fiber-optic viewing scope into the abdominal cavity through a small incision. The surgeon uses other devices to remove the adrenal tumor through additional small incisions. This procedure usually causes less pain than other approaches and often permits a shorter stay in the hospital. Although most adrenal cancers can be removed using this technique, some surgeons prefer other methods to remove large or potentially malignant adrenal tumors.

The procedure recommended will depend on the size and type of tumor and the needs of the patient. Patients with tumors that produce hormones such as adrenaline require special medications to control blood pressure prior to and during surgery. At Mayo Clinic, endocrinologists and anesthesiologists take precautions to combat complications that may arise from the body's release of excess hormones during surgery.

Under certain circumstances, surgeons perform palliative tumor debulking (reducing) surgeries to improve the quality of life and survival of patients with metastatic adrenal cancers. In this noncurative procedure, surgeons remove as much of the tumor as is safely possible to relieve symptoms of the cancer.

Radiation Therapy

Radiation can be directed toward the adrenal glands or other locations to which the adrenal cancer has spread. It destroys cancer cells and reduces a tumor's size. Most commonly, radiation oncologists deliver radiation to the tumor site from a source outside of the body. Radiation can be used in combination with other therapies such as chemotherapy. Recently, Mayo Clinic surgeons and radiation oncologists conducted tests on the effectiveness of intraoperative electron beam radiation directed at the tumor during surgery to limit damage to surrounding tissue.

Chemotherapy

Medical oncologists give chemotherapy to patients who have adrenal cancer that cannot be cured with surgery. The drugs can be given orally or intravenously depending upon the patient's situation and the type of cancer. Often physicians combine chemotherapy with radiation therapy, surgery and directed tumor ablation. Chemotherapy alone seldom results in complete remission from adrenal cancer.

Radiofrequency Ablation

An innovative form of radiation therapy, radiofrequency ablation (RFA) destroys tumor cells with electricity delivered through a needle. When appropriate, this technique may allow a less invasive, directed approach to treating adrenal tumors that have spread to bone or the liver.

Medications

Mayo Clinic specialists often use medicine to control symptoms and problems produced by hormones secreted by adrenal tumors. Endocrinologists assist other Mayo physicians in optimizing medications and preparing patients for surgery.