Adrenal cancer occurs when a tumor grows in one or both of your adrenal glands. Often, it doesn't have any symptoms. Tumors are usually discovered by accident during an ultrasound, MRI or CT scan for another condition.
Adrenal glands are small endocrine glands located above your kidneys. Each gland has two parts: the cortex (outer layer) and the medulla (the inner area). Both parts produce hormones in the body. The hormones help you stay healthy, regulate your response to stress, and cause your body to have masculine or feminine characteristics. Adrenal cancer is rare, with estimates of approximately 200 cases per year. Types of adrenal cancers include:
- Adrenocortical carcinoma (ACC): This is the most common type of adrenal cancer, which forms in the cortex. Usually, tumors are discovered when they grow and cause pain or a feeling of fullness, resulting in weight loss. The condition may also cause weight gain, excess facial hair or early puberty.
- Pheochromocytoma and paraganglioma: These are rare and typically benign tumors that come from the same type of tissue. Pheochromocytoma forms in the adrenal medulla (the center of the adrenal gland). Paragangliomas form outside the adrenal gland. These types of adrenal cancer typically originate from adrenaline-producing cells. Symptoms are commonly associated with increased adrenaline levels and can include higher blood pressure, excess sweating, racing heart and anxiety.
- Primary macronodular adrenal hyperplasia (PMAH): Not considered cancer, PMAH is characterized by multiple lumps (nodules) in the adrenal glands. These nodules are usually found in both adrenal glands and vary in size. They cause adrenal gland enlargement and production of higher-than-normal levels of cortisol, a hormone that suppresses inflammation and protects your body from physical stress such as infection or trauma. PMAH is considered a form of Cushing's syndrome, which can cause problems related to the overproduction of hormones.
In approximately 60 percent of people, symptoms related to excessive hormone secretion are the main reasons for seeking medical attention.
Tests
Blood and Urine Tests
Sylvester is the only center in South Florida with a specialty Endocrine Testing Center. Located at the University of Miami Miller School of Medicine, the center is staffed by specialized nurses and technical assistants who perform complex hormone tests.
CT Scan (Computed Tomography)
A CT scan, also called a CAT scan, takes a series of detailed pictures of inside your body, taken from different angles. It's used to determine the extent of cancer and plan treatment.
MRI (Magnetic Resonance Imaging)
MRI combines a magnet, radio waves and a computer to create a series of detailed pictures of the inside of your body. As with CT scans, MRI can help to determine the extent of cancer and plan treatment.
PET Scan (Positron Emission Tomography)
A PET scan is an imaging test that uses a special radioactive dye (tracer). The dye is injected into a vein in your arm, and your organs and tissues absorb it. If cancer cells are present, they appear brighter than normal cells.
Adrenal Angiography
This procedure allows your doctor to see your arteries and examine blood flow near your adrenal glands. Before the exam, you receive an injection of contrast dye in your adrenal arteries. As the dye moves through your arteries, a series of X-rays are taken to see if any arteries are blocked.
Adrenal Venography/Vein Sampling
Similar to adrenal angiography, this exam looks at your adrenal veins and blood flow using contrast dye and X-rays. In some instances, a catheter (thin, flexible tube) may be inserted into your vein to take a blood sample, which is checked for abnormal hormone levels.
MIBG Scan
This scan is done by injecting a very small amount of radioactive material (MIBG) into your vein, which travels through your bloodstream. Adrenal gland cells absorb the radioactive material, and the cells are detected by a device that measures radiation. This scan helps your doctor tell the difference between adrenocortical carcinoma and pheochromocytoma of the medulla.
Biopsy
A biopsy removes a small part of the suspicious area to analyze. Also, we might recommend an adrenalectomy (removal of a whole adrenal gland) to determine the type and stage of disease.
Multigene Tests
Because no tumor has a single mutation, genomic profiling allows the pathologist to identify groups of mutations in your tumor tissue sample and create a tumor profile for you.
Treatments
Surgery
Surgery is the main treatment for adrenal cancer. The goal of surgery is to remove the tumor, the adrenal gland (adrenalectomy) and sometimes nearby lymph nodes. Surgery can be done through an open procedure (open surgery) or with minimally invasive procedures that use tiny incisions, such as robotic-assisted surgery. Minimally invasive approaches offer precision, less blood loss, and faster healing.
Radiofrequency Ablation
This procedure uses radio waves that heat and destroy abnormal cells. The radio waves travel through electrodes inserted into the tumor area.
Cryoablation
Rather than using heat, this procedure uses liquid nitrogen or liquid carbon dioxide to freeze the tissue and destroy abnormal cells.
Transarterial Embolization Therapy
This surgical treatment blocks the artery leading to the adrenal gland and interrupts the flow of blood, killing any cancer cells growing there.
NanoKnife® (Irreversible Electroporation or IRE)
Sylvester was the first provider in Florida and is one of only a handful in the world to provide this treatment for selected primary tumors considered inoperable. Not technically surgery, the procedure is an advanced type of radiation therapy. Under CT scan or ultrasound guidance, our interventional radiologists insert electrodes on or near the tumor. NanoKnife sends intense, electric pulses directly to the tumor, which causes cancer cells to die while leaving healthy tissue unharmed.
Radiation Therapy
IMRT (Intensity modulated radiation therapy) is a type of external-beam radiation therapy. It creates a 3D beam matched to the shape of a tumor. It’s often an ideal choice for adrenal gland tumors, which are irregularly shaped. Radiation specialists also can vary the amount of radiation in each beam targeted at the tumor. The precise control and flexibility of IMRT minimize the amount of radiation to nearby healthy tissue. For adrenocortical cancer, radiation is given externally.
Chemotherapy (Systemic Medical Therapy)
Chemotherapy is cancer-fighting medicine given as a pill or intravenously (via a needle). In most cases, chemotherapy works by interfering with the cancer cell’s ability to grow or reproduce.
Locations: If you need intravenous (infusion) chemotherapy, you can have it at the Comprehensive Treatment Unit (CTU) at Sylvester’s main location in Miami, a 12,000-square-foot unit that includes 33 recliners and 11 private rooms. If you prefer, you may have your infusion treatments at the Kendall, Plantation, Hollywood, Coral Springs, Coral Gables, or Deerfield Beach locations.
Hormone-Regulating Therapy
If you have pheochromocytoma of the adrenal medulla that causes symptoms, these are treated with drug therapy, starting at diagnosis. Usually, drug therapy is used one to three weeks before surgery. Therapy may include:
- Medicines that keep blood pressure normal:One type of medicine, alpha-blockers, stop noradrenaline from narrowing small blood vessels. This lowers blood pressure and improves blood flow.
- Medicines that regulate heart rate: Beta-blockers block the effect of the hormone noradrenaline to slow down your heart rate and restore a regular heartbeat.
- Medicines that block the effect of extra hormones made by the adrenal gland: Your body may secrete additional hormones that need to be blocked. Our expert endocrinologists will regulate your hormone production as needed.
Targeted Therapy
Targeted therapies are medicines that stop a cancer cell's ability to grow and spread. They target only cancer cells, rather than all rapidly growing cells, such as with chemotherapy. Adrenocortical cancers that don't respond to the usual treatments may be treated with targeted therapy. Medicines are taken at home as a pill once a day. Doctors use targeted therapies to treat both metastatic and recurrent pheochromocytoma.
Immunotherapy (Biologic Therapy)
This treatment uses substances made by your body or made in a laboratory to boost, direct or restore your natural defenses against cancer.
Why Choose Sylvester Comprehensive Cancer Center?
Sylvester is an NCI-designated cancer center. The National Cancer Institute has reaffirmed us as South Florida’s only NCI-designated cancer center. We have been recognized for our scientific leadership, our commitment to training the next generation of cancer researchers and providers, as well as our engagement with the communities that we serve. For patients, this designation translates into greater access to leading-edge treatment options, including clinical trials that prioritize your specific cancer.
Only center in South Florida with a specialty endocrine testing center. You receive greater accuracy in your diagnosis, leading to more precise treatments and better results. Located at the University of Miami Miller School of Medicine, the center is staffed by specialized nurses and technical assistants who perform complex hormone tests.
Advanced radiation oncology tools. Our RapidArc® radiotherapy system delivers intensity modulated external radiation therapy (IMRT). This leads to more efficient and effective treatments, shorter treatment times, pinpoint accuracy in tumor targeting, and less damage to surrounding healthy tissue.
More cancer clinical trials than any other South Florida hospital. If appropriate for your cancer and stage, our clinical trials provide you with the newest ways to treat and potentially cure your cancer.
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