It may not seem like it, but your body constantly changes from one moment to the next. A tweak here to lower your blood sugar, a boost there to increase your blood flow. It’s a complex balancing act to give each part of your body exactly what’s needed, whether you’re baking a cake or running a marathon.
Your adrenal glands, one on each kidney, help in this process by making hormones, which are messengers that tell your organs what they need to do next. They control everything from your blood pressure to your mood.
When you have adrenal carcinoma (also called adrenal cancer or adrenocortical cancer) you have a cancerous tumor in your adrenal cortex. This is the outer part of your adrenal gland. Adrenal carcinoma is rare. Your doctors may be able to cure it if you catch it early. But it’s aggressive. That means it spreads quickly, and if it moves beyond the adrenal gland it’s much harder to treat.
Causes
Doctors aren’t sure what causes adrenal cancer. It starts with a change in the genes of some adrenal cells, but that change seems to happen at random.
It can run in families, so if anyone in your family has cancer in their adrenal glands or other parts of the endocrine system, tell your doctor. If you do get it, regular checkups can help you catch it early.
When you have a genetic condition, you have a defect in one or more genes. Some genetic conditions may give you higher odds of getting adrenal cancer:
- Beckwith-Wiedemann syndrome
- Familial adenomatous polyposis (FAP)
- Hereditary nonpolyposis colorectal cancer (HNPC)
- Li-Fraumeni syndrome
- Multiple endocrine neoplasia (MEN1)
Symptoms
Some tumors are functioning, meaning they overproduce one of the hormones normally made in the adrenal gland. Others are nonfunctioning, meaning they don’t make hormones. As they grow, both types of tumors can press on your organs and cause:
- Pain in your belly, side, or back
- A feeling of fullness that may keep you from eating much
- A lump in your belly
You’ll likely get other symptoms only if you have a functioning tumor, which would give you higher-than-normal hormone levels. Your symptoms depend on which hormone the tumor makes:
Aldosterone. Too much of this hormone can cause problems, such as:
- High blood pressure
- Peeing more than normal
- Weak muscles and cramping
Cortisol. Too much cortisol causes many symptoms, including:
- Easy bruising
- High blood pressure
- High blood sugar
- Extra fat on the back of your neck
- Mood swings
- Purple or pink stretch marks
- Very round, red face
- Weight gain in the face, neck and torso, but thin arms and legs
Estrogen. In women, too much estrogen may lead to issues like:
- Menstrual periods that aren’t regular
- Vaginal bleeding in women after menopause
- Weight gain
In men, too much estrogen can cause breast growth, low sex drive and trouble getting an erection.
Testosterone. Too much testosterone tends not to cause problems in men, but women with too much may have a deeper voice and hair loss, and might stop having their period.
Diagnosis
Your doctor will start with questions about your symptoms, health history, and cancer in your family. You’ll also get a physical exam -- your doctor will feel around your belly for a tumor.
From there, you’ll likely get different blood and urine tests to check your hormone levels -- high levels can be a sign of a tumor, but doesn’t mean it’s cancer.
Your doctor may also use:
- CT scan. This is the most common type of imaging to look for adrenal gland tumors.
- MRIisn’t used as much as CT, but it can be helpful.
- Laparoscopy. Your doctor uses a thin, flexible tube with a camera on the end -- a laparoscope -- that goes into an opening made in your side to see the cancer. It can help the doctor decide whether surgery could remove the cancer and removal can be done at the same time.
- PET scan. This can help your doctor figure out if a tumor is cancer or not.
Because your adrenal glands are close to some important blood vessels, you may also get adrenal angiography or adrenal venography. These tests check blood flow in the arteries and veins around your adrenal gland.
Unlike other cancers, you probably won’t get a biopsy before surgery to remove the adrenal gland and the mass for evaluation, if the imaging tests and blood tests are enough.
Treatment
If you are diagnosed with an adrenal carcinoma, treatment depends on the size of the tumor, how far it’s spread, and your overall health. Options may include:
- Surgery to take out the adrenal gland. This is the treatment doctors prefer. It’s the only way to cure adrenal cancer. But if the cancer has spread too far, it’s not an option.
- Chemotherapy to kill cancer cells with drugs. It’s often used if you can’t get surgery. It may also be used after surgery to kill off any last cancer cells.
- Radiation therapyto destroy cancer cells with high energy from X-rays or other sources. You may get radiation if surgery couldn’t remove all the cancer, or if the cancer comes back after surgery. It’s often used more to ease your symptoms than to cure the cancer.
