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Overview
An adrenal gland is located on
top of each kidney. Each gland is composed of the
adrenal medulla and the adrenal cortex. Each
section has a different function, but the overall
function of the gland is to produce steroid
hormones.
Most malignancies of the adrenal
gland occur in the cortex. Carcinomas of the
adrenal gland are either functional or
nonfunctional (i.e., they either produce steroids
leading to clinical symptoms or they do not). This
disease is very rare, affecting two people per 1
million.
Staging
Staging gauges the size and
location of the tumor using information from
imaging studies (e.g., CT scans, MRIs), pathology
reports, and physical examination. Staging helps
the physician make a prognosis and determine
treatment.
The staging of adrenal carcinoma
places patients into one of four categories
according to tumor size, the presence or absence
of invasion into the kidney or other nearby
organs, the presence or absence of lymph node
involvement, and the presence or absence of
distant disease (e.g., lung, liver, or bone
involvement). Stages may be divided into the
following:
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Stage 1:
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Small tumors (less than 2
inches) without evidence of local invasion;
absence of nodal involvement and absence of
distant disease. |
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Stage 2:
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Tumors larger than 2 inches
without evidence of local invasion; absence
of nodal involvement and absence of distant
disease. |
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Stage 3:
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Tumors of any size with nodal
involvement. |
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Stage 4:
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Tumors that invade adjacent
structures; any tumor that has evidence of
distant spread; or any tumor that has
invaded the kidney and has positive nodal
involvement. |
Signs and
Symptoms
Signs of adrenal cancer include
abdominal pain, weight loss, and weakness. A
functional tumor on the adrenal cortex can
overproduce hormones (e.g., aldosterone,
testosterone, estrogen, etc.) and lead to disease:
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Conn's syndrome (too much
aldosterone; causing hypertension and
hypokalemia)
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Cushing's syndrome (too much
cortisol, a steroid hormone; causing obesity,
hypertension, osteoporosis)
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Hypertension
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Diabetes
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Osteoporosis
Signs caused by the overproduction
of sex hormones may include a deepening of the
voice and beard growth in women (associated with
too much testosterone) and redistribution of
weight and breast development in men (associated
with too much estrogen).
Diagnosis
Blood testing for hormone
overproduction is necessary to determine the
presence of a tumor. A functioning tumor (hormone
producing) may not be malignant. Computerized
tomography (CAT) scan and magnetic resonance
imaging (MRI) are two common methods used to view
the kidneys and adrenal glands.
Prognosis
Prognosis is determined by the cancer's stage and
aggressiveness (defined by number of cells
dividing when examined under a microscope).
Treatment
Surgery is the treatment of
choice and is performed whenever possible, except
when there is evidence of distant spread. If there
is pain, surgery may alleviate symptoms.
Radiation may be an option for
patients who cannot undergo surgery, or for those
who undergo incomplete resection. Chemotherapy has
not been shown to be effective as a single agent;
however, combinations of agents are more effective
and may be considered.
Mitotane (a chemical previously
used as a pesticide) may have better results than
chemotherapy. Side effects include severe nausea
and vomiting. The most commonly used combination
chemotherapy regimen consists of three drugs: 5FU,
adriamycin, and cisplatinum.
The major side effects of
these medications include:
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Anemia
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Decreased heart function
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Diarrhea
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Hair loss
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Impaired hearing
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Loss of appetite and weight loss
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Mouth sores
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Nausea
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Risk for bleeding
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Risk for infection
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Skin rash
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Tingling and numbness
(neuropathy)
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Vomiting
The associated risks of treatment
should be weighed against the benefits expected
and discussed with the physician.
In patients with completely
resected stage 1, 2, or 3 disease, no adjuvant
treatment is indicated, but participation in a
clinical trial (if one is available) may be
considered.
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