What is Adrenal Cancer? Symptoms, Causes and Treatment Methods

Adrenal Cancer

Adrenal glands are small, triangular-shaped structures located just above the kidneys. Each person has two adrenal glands, and these glands play a vital role in maintaining the body's hormonal balance. Malignant adrenal cancer is a rare but serious type of tumor that begins in these hormone-producing tissues. This type of cancer is commonly referred to as adrenocortical carcinoma and typically starts in the outer layer known as the adrenal cortex. Here, cancer cells multiply uncontrollably, affecting hormone production and carrying the potential to spread to surrounding tissues or distant organs. Therefore, early diagnosis is of great importance; however, the fact that symptoms can be confused with other diseases can complicate the process.

What is Adrenal Cancer?

Adrenal cancer is a rare but serious type of cancer that develops in the adrenal glands, which are located just above the kidneys and are responsible for hormone production. Cancer can cause hormonal imbalances in the body through the adrenal glands. These glands secrete vital hormones such as cortisol, which regulates the stress response, aldosterone, which affects blood pressure, and sex hormones. Cancer usually begins in the outer part of the gland, namely the adrenal cortex, and is most often called adrenocortical carcinoma. This tumor can be mistaken for a benign mass. When malignant, it grows uncontrollably, disrupts the hormone balance, and carries the potential to spread to other organs. While some tumors produce hormones, others may not; this directly affects the severity of symptoms and the time of detection. Although rare, it is an aggressive type of cancer that poses a life-threatening risk if diagnosed and treated in a timely manner.

What Are the Symptoms of Adrenal Cancer?

The symptoms of adrenal cancer can vary from person to person. The primary reason for this is whether or not the tumor secretes hormones. Hormone-producing tumors can disrupt the body's hormonal balance and lead to some striking symptoms. For example, in women, signs of virilization such as abnormal hair growth, menstrual irregularities, and deepening of the voice may occur. In men, conditions such as breast enlargement or loss of libido may develop. Apart from these, symptoms such as high blood pressure, weight gain, muscle weakness, sudden mood changes, bruising on the skin, and abdominal pain may also be observed; however, if the tumor does not produce hormones, symptoms may be more subtle and usually manifest as pain in the back or abdominal region due to the growth of the mass.

What Causes Adrenal Cancer?

Although the exact cause of this type of cancer is often unknown, it is thought to be associated with certain genetic predispositions and hereditary syndromes. Certain hereditary disorders such as Li-Fraumeni syndrome, Beckwith-Wiedemann syndrome, and multiple endocrine neoplasia (MEN) type 1 can increase an individual's risk of developing adrenal cancer. Aside from these, research is also being conducted on the indirect effects of environmental factors, particularly long-term stress or exposure to certain chemicals. Currently, there is no clearly defined environmental cause specific to this disease.

How is Adrenal Cancer Diagnosed?

The diagnosis of adrenal cancer typically begins with the evaluation of an adrenal mass discovered incidentally while investigating another health problem. The stages of adrenal cancer are determined based on the size of the tumor, its spread to surrounding tissues, and the presence of metastasis. Stage 4 adrenal cancer represents the most advanced stage of the disease and usually involves distant organ metastasis. If the patient has certain symptoms related to hormone excess (such as sudden weight gain, high blood pressure, increased body hair in women, or breast enlargement in men), these symptoms raise suspicion for the physician. In the initial stage, blood and urine tests are used to investigate whether the adrenal gland is overproducing hormones. Subsequently, imaging methods are utilized to evaluate the presence and structure of the mass. Computed tomography (CT) and magnetic resonance imaging (MRI) clearly show the size, borders, and potential spread of the adrenal mass. In some cases, advanced imaging techniques such as positron emission tomography (PET) may also be required. If the tumor is surgically removed, pathological examination of the retrieved tissue provides a definitive diagnosis. During this process, details such as whether the tumor is benign or malignant, how rapidly the cells are multiplying, and whether the cancer has spread to other organs are clarified. Making a diagnosis requires careful evaluation and generally necessitates a multidisciplinary approach where endocrinology, radiology, pathology, and oncology specialists work together.

How is Adrenal Cancer Treated?

Adrenal cancer treatment is planned individually for each patient, taking into account the stage of the tumor, whether it produces hormones, and the patient's general health status. If the cancer is caught at an early stage and has not spread to other organs, the most effective treatment method is surgery. During this surgery, the tumor-bearing adrenal gland is generally removed completely along with the surrounding tissues. Whether the surgery is performed using open or laparoscopic (closed) methods depends on the size of the tumor and its relationship with surrounding tissues. In cases where the tumor cannot be completely removed or has spread to other parts of the body, additional treatments are needed. At this stage, chemotherapy, radiotherapy, and certain targeted drug therapies come into play. Chemotherapy can usually be administered with or independently of the active substance mitotane. In some patients, radiotherapy is preferred to destroy remaining cells after surgery or to reduce pain. The treatment process consists of more than just physical interventions; the patient's psychological state, quality of life, and follow-up plan are also vital parts of this process. Following treatment, regular check-ups should be conducted to monitor whether the disease has recurred, and intervention should be made if necessary.

Frequently Asked Questions

Adrenal cyst cancer is a very rare disease. It accounts for a very small percentage of all cancer cases and is diagnosed in only 1 to 2 people per million per year. Therefore, it has a high probability of being overlooked by both patients and healthcare professionals. Particularly, the similarity of symptoms to other common diseases can cause delays in diagnosis. Its rarity does not mean it should be disregarded; on the contrary, because it can follow an aggressive course, early diagnosis and proper treatment are of great importance. Additionally, this type of cancer can occur in conjunction with certain hereditary diseases, which causes an increased risk in individuals with genetic predisposition. Adrenal cancer in infants is rare and can often be confused with neuroblastoma. Its rarity can make the management of the disease difficult because many centers may not have sufficient experience. Therefore, it is recommended that individuals diagnosed with adrenal cancer continue their treatment process in specialized centers focusing on this field. This type of cancer can predominantly affect hormones such as cortisol, aldosterone, androgens, and estrogens. Symptoms vary depending on the type of hormone secreted. Excess cortisol causes Cushing's syndrome, while the production of androgens and estrogens leads to sex-related symptoms in women and men. The detection of the disease is mostly incidental. A mass in the adrenal gland may be noticed during imaging performed for another reason, but a person may also consult a doctor when symptoms related to hormone production appear. Hormone tests and imaging examinations provide important clues leading to diagnosis. As the tumor grows, it can put pressure on surrounding tissues, leading to pain in the abdomen, back, or waist region. Pain is usually absent in the early stages. Symptoms related to hormonal imbalances are more prominent. Adrenal cancer metastasis can be in the form of spreading to distant organs such as the liver, lungs, or bones. In this case, the treatment becomes more complex, and the patient's life expectancy and quality can be severely affected. Lung cancer spreading to the adrenal gland is a frequently encountered form of spread in advanced disease. Adrenal metastasis of lung cancer can be detected by imaging methods and confirmed by a biopsy. Symptoms of adrenal metastasis from lung cancer are often not distinct and are usually detected incidentally. Treatment for lung cancer adrenal metastasis can be planned with chemotherapy, targeted therapy, or immunotherapy. Surgery is the most effective treatment method for the disease. Especially if the cancer is confined solely to the adrenal gland, the surgical success rate is high. Recovery can be achieved by removing the tumor and surrounding tissues via laparoscopic or open surgery. Although it may not be necessary for every patient, chemotherapy is an important treatment option in cases where the cancer has spread. It can also be administered to destroy remaining cells after surgery. Adrenal cancer can recur. This type of cancer can follow an aggressive course by nature, and the risk of the disease relapsing increases, especially if the tumor could not be completely removed or if the diagnosis was made at an advanced stage. The first few years after treatment are the most critical period regarding recurrence. During this process, the tumor can re-form at its original site or manifest as a spread to distant organs (metastasis). The risk of recurrence varies depending on the cellular characteristics of the tumor, its potential for spread, the success of the applied treatment, and the patient's general health status. Therefore, even after surgery, patients must definitely be monitored at specific intervals. The disease is kept under control through blood tests, hormone level measurements, and regular imaging examinations. Certain medications, especially mitotane, can be used long-term after surgery to reduce the risk of relapse. Life expectancy varies significantly depending on the stage at diagnosis. In patients diagnosed at an early stage and treated successfully, the 5-year survival rate is over 50%. This rate decreases in advanced stages. The individual's general health status and response to treatment are also important determinants. An endocrinology specialist is the first branch to consult in order to evaluate the disease's relationship with hormones. Once the diagnosis is clarified, if surgical intervention is required, general surgery or urology specialists step in. An oncology specialist guides the chemotherapy or radiotherapy portion of the treatment.

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