Adrenal cancers occur when abnormal cells form in or travel to the adrenal glands. There are two adrenal glands, one located above each kidney. Adrenal cancer usually occurs in the outermost layer of the glands, which is called the adrenal cortex. It usually appears as a tumor.
A noncancerous tumor of the adrenal gland that must be differentiated from an adrenal cancer is a benign adenoma. Benign adenomas are relatively small, usually less than 2 inches in diameter.
Most people with this type of tumor have no symptoms. These benign tumors usually occur on only one adrenal gland but can sometimes appear on both.
An adrenal cortical carcinoma is a cancerous tumor. These tumors can sometimes produce hormones that cause changes in the body.
In some cases they get large enough to start pressing on your organs, causing more symptoms. It is also common for adrenal cortical carcinomas to be much larger than benign adenomas. If a tumor is more than two inches in diameter, it is likely cancerous.
If there is cancer in the adrenal glands, but it did not begin there, it is not considered an adrenal cortical carcinoma.
What Causes Adrenal Cancer?
At this point scientists do not know exactly what causes adrenal cancer.
What are the Risk Factors for Adrenal Cancer?
Certain conditions put you at a greater risk for adrenal cancer including:
- Beckwith-Wiedemann syndrome (abnormal growth disorder with large body and organs)
- Li-Fraumeni syndrome (inherited disorder with an increased incidence of cancers)
- familial adenomatous polyposis (inherited condition with many polyps in the large intestines)
- multiple endocrine neoplasia (many tumors, benign or malignant, in glands that produce hormones)
- Smoking is also believed to increase the risk of adrenal cancer, but it has yet to be proven conclusively.
Symptoms of Adrenal Cancer
In most cases, symptoms of adrenal cancer are caused by excess production of the hormones androgen and estrogen. Symptoms may also arise from large tumors pressing on organs of the body.
Symptoms of excessive hormone production are easier to spot in children than adults because physical changes are more active and visible in puberty. Some signs of adrenal cancer in children are:
- excessive hair growth (pubic, underarm, and facial)
- enlarged penis
- enlarged clitoris
- large breasts in boys
- early puberty in girls
Symptoms of adrenal cancer in adult women are usually harder to detect. They usually do not appear until the tumor is large enough to press on the organs. In men, if the adrenal tumor causes increased estrogen, there may be slight enlargement of the breasts and noticeable tenderness.
Women with tumors that cause increases in androgen may notice facial hair growth or deepening of the voice.
Some other symptoms are:
- high blood pressure
- weight gain
- irregular periods
- easy bruising
- frequent urination
- muscle cramps
How is Adrenal Cancer Diagnosed?
Diagnosing adrenal cancer usually begins with your medical history and a physical exam. Your doctor will also draw blood and collect a urine sample for testing. Your physician may order further tests such as:
- computed tomography (CT) scan
- positron emission tomography (PET) scan
- magnetic resonance imaging (MRI)
- adrenal angiography
How is Adrenal Cancer Treated
Adrenal cancer can be cured if the treatment is given early on. Some methods of adrenal cancer treatment are as follows:
- Laparoscopic adrenalectomy is done when a surgeon makes small incisions in the abdomen and removes the tumor using a small camera.
- Transabdominal surgery involves a large incision in the abdomen and removal of the tumor. The surgeon will check the surrounding organs for cancer.
- Posterior surgery involves an incision being made in the back for tumor removal.
- Thoracoabdominal surgery is done to remove a particularly large tumor. It involves an incision through the abdomen and chest.
If the tumor has metastasized or spread to other parts of the body, it may be treated with radiation or chemotherapy.
For tumors that are too big to be removed safely, cryoablation, or the destruction of tumor cells with freezing, may be performed.
Medication like mitotane, which prevents the adrenal glands from producing steroid hormones, may also be prescribed if you have stage II, III, or IV adrenal cancer.
What is the Long-Term Outlook?
Follow-up appointments with your doctor are very important if you have had adrenal tumors. Adrenal cancer can come back at any time.
If you took mitotane as part of your treatment, your doctor may prescribe hormones to compensate for the hormone suppression caused by mitotane.
Adrenal cortex tumors
There are 2 main types of adrenal cortex tumors: benign (non-cancerous) and malignant (cancers). Most of these tumors are benign and are called adenomas.
Cancers of the adrenal cortex are rare. These 2 types of tumors can sometimes be hard to tell apart when the cells are looked at under the microscope.
Although experienced pathologists (doctors that are trained to diagnose diseases by looking at tissue under the microscope) can tell the difference in most cases, sometimes the only way to know for sure that the tumor is a cancer is when it spreads
. If it spreads to lymph nodes or other organs and tissues, it is a cancer.
Adenomas do not spread outside the adrenal gland.
Adrenal cortex adenomas
Most tumors of the adrenal cortex are not cancer. They are benign tumors known as adenomas. These tumors are small, usually less than 2 inches (5 centimeters) across. They usually occur in only a single adrenal gland, but sometimes affect both.
Most people with adrenal adenomas have no symptoms and are unaware that they have an adrenal tumor. Some of these adenomas are discovered by accident (incidentally) when CT or MRI scans of the abdomen are done because of an unrelated health problem.
About 5% of people who have a CT scan of the abdomen are found to have an adrenal tumor that was not suspected.
Many of these are nonfunctional, meaning that they don’t make adrenal hormones. Sometimes these tumors are known by the nickname incidentalomas because they aren’t causing problems and were only found by accident.
Some adenomas produce too much adrenal steroid hormones. Sometimes the excess hormone can cause symptoms.
Many of the hormone-related symptoms of adenomas are the same as those from adrenal carcinomas (cancers).
These symptoms are discussed in the section, “Signs and symptoms of adrenal cancer.” Adenomas are much more likely than carcinomas to produce high levels of aldosterone, which can cause high blood pressure.
Treatment: Adenomas can be cured by removing the adrenal gland that contains the adenoma. Some adrenal adenomas that cause hormone-related symptoms can be treated effectively with medicines to block the production or actions of these hormones.
This may be the best treatment choice for patients with other serious medical problems who might not be able to withstand a major operation.
The treatment of incidentalomas depends on the chance that it may be a cancer and whether or not it is raising hormone levels.
When an adrenal tumor is found accidentally, tests are often done to see if it is making hormones. If it is, surgery is often recommended.
Otherwise, surgery may only be recommended if it is likely to be a cancer. Small tumors are less likely to be cancer, and are often watched but not treated.
The CT (or MRI) scan can be repeated in 6 to 24 months to see if the tumor has grown. If it has, it may need to be removed.
If it hasn’t grown, hormone levels will be watched over the next few years. If the tumor remains small and doesn’t make any hormones, it may not need to be treated at all.
The remainder of this document refers to adrenal cancers only, and not to adenomas.
Adrenal cortical cancer
The type of cancer that develops in the cortex of the adrenal gland is called adrenal cortical carcinoma. It is also known as adrenocortical cancer (or carcinoma) or just adrenal cancer.
In this document, the term adrenal cancer is used to mean cancer that starts in the adrenal cortex.
Adrenal cancer most often is discovered when:
It is found accidentally on an imaging test done looking for something else.
It produces hormones that cause changes such as weight gain and fluid retention, early puberty in children, or excess facial or body hair growth in women.
It starts causing symptoms because it has gotten very large. Large tumors can press on other organs in the abdomen, causing pain or a feeling of fullness.
Generally, adrenal cancers are much larger than adrenal adenomas.
An adrenal tumor larger than 5 or 6 centimeters (about 2 to 2 1/2 inches) is assumed to be a cancer. In one study, the average size of an adrenal cancer was about 13 cm (or 5 inches).
Most cancers found in the adrenal gland did not start there and are not adrenal cancers. Instead, they start in other organs or tissues and then spread (metastasize) through the bloodstream to the adrenal glands.
For example, lung cancers, melanomas, and breast cancers often spread to the adrenals. Even when other cancers spread to the adrenals; however, they are still named after the place they started and are treated like other cancers that start in the same place.
They are not considered adrenal cancer. Their treatment is described in our documents on these cancers.