Adrenal cancer is a type of cancer that affects the adrenal glands, which are the components of the endocrine system responsible for manufacturing various steroid hormones. Since these triangular-shaped glands are positioned just above each kidney, they are sometimes referred to as the suprarenal glands. Each gland consists of two parts. The adrenal cortex is the outer layer of the gland that produces cortisol to regulate glucose utilization in the body, as well as androgen hormones related to sexual maturation and fertility. The inner layer, or adrenal medulla, secretes epinephrine (also known as adrenaline) and norepinephrine, which regulate mood and concentration.
Although this condition is named adrenal cancer, it is actually quite rare for the adrenal glands to be the source of malignancy. In fact, adrenal cancer most often occurs when cancer invades another part of the body, such as such as lung or breast cancer, and then metastasizes to the adrenal glands through the lymph nodes. However, adrenal cancer can directly stem from the adrenal cortex, which is referred to as adrenal cortical cancer. In this case, the cancer is categorized as either functional or non-functional, which depends on whether steroid hormones are produced or not. In addition, the most common tumor to form in the adrenal glands is an adrenal adenoma, which is actually benign.
Unfortunately, symptoms of adrenal cancer may not present themselves until the condition has advanced. This is why this type of cancer is difficult to diagnose in its early stages. In fact, it is often only discovered after the patient undergoes an imaging test for another reason. However, if the adrenal cancer is functioning and producing hormones, or has grown to the point of invading the abdominal cavity, then symptoms are likely to occur. These include feeling full after eating a small amount of food, abdominal pain, high blood pressure, behavioral or physical changes due to excessive hormone production, fever, and unexplained weight loss.
Adrenal cancer can lead to other complications. If high blood pressure is present, Conn’s syndrome may be suspected. This secondary condition is due to excessive aldosterone secretion and is characterized by a reduction of circulating potassium in the blood. It is also marked by a decrease in an enzyme produced by the kidneys called rennin. However, an excessive production of cortisol may lead to the development of Cushing's syndrome instead, which is accompanied by compromised immunity, an overgrowth of body hair, water retention, and weight gain.
Diagnosis of adrenal cancer begins with a physical examination and an investigation of symptoms. If symptoms cannot be ruled out by another cause, the clinician will follow up with blood tests to measure serum levels of steroid hormones and potassium. Various imaging tests are also typically ordered, such as positron emission tomography (PET), a computed tomographic (CT) scan, and magnetic resonance imaging (MRI).
Treatment of adrenal cancer is usually supervised by an endocrinologist and may involve medications to manage symptoms. However, surgery is often indicated, as well as radiation and/or chemotherapy. Surgical procedures include transabdominal surgery, thoracoabdominal surgery (for large tumors), and posterior surgery to access the adrenal glands directly from the back.
