There are two adrenal glands, one above each kidney in the back of the upper abdomen. Each adrenal gland is composed of two layers : -
The adrenal cortex, or outer layer of the adrenal gland, which produces a variety of steroid hormones.
The adrenal medulla, or inner layer of the adrenal gland, which produces the hormones epinephrine and norepinephrine.
Cancer of the adrenal cortex, also called adrenocortical carcinoma, is discussed below. (Cancer of the adrenal medulla, also called pheochromocytoma, is discussed separately.)
The cells in the adrenal cortex make important hormones that help the body function properly. When cells in the adrenal cortex become cancerous, they may make too much of one or more hormones, which can cause symptoms such as high blood pressure, weakening of the bones, or diabetes. Cancers that make hormones are called functioning tumors. However, many cancers of the adrenal cortex do not make extra hormones and are called nonfunctioning tumors.
A person with the following symptoms should see a doctor: pain in the abdomen, loss of weight without dieting, and weakness. If there is a functioning tumor, there may be symptoms or signs caused by too many hormones, such as high blood pressure, weakening of the bones, or diabetes.
If a patient has symptoms of cancer of the adrenal cortex, the doctor will order blood and urine tests to see whether the amounts of hormones in the body are normal. A doctor may also order a computed tomography scan, a special x-ray that uses a computer to make a picture of the inside of the abdomen. Other special x-rays may also be taken to determine what kind of tumor is present.
The chance of recovery (prognosis) from cancer of the adrenal cortex depends on how far the cancer has spread (the stage of the disease) and on whether a doctor is able to surgically remove all of the cancer.
Stages
Once cancer of the adrenal cortex has been diagnosed, more testing will be done to see how far the cancer has spread-a process called staging.
Treatment options vary depending on the stage of the disease. The following stages are used for cancer of the adrenal cortex:
Stage I : -The cancer is less than 5 centimeters (less than 2 inches) wide and has not spread into tissues around the adrenal gland. During this stage, the primary treatment will probably be surgery to remove the cancer.
Stage II : - The cancer is more than 5 centimeters (less than 2 inches) wide and has not spread into tissues around the adrenal gland. During this stage, the primary treatment will probably be surgery to remove the cancer, although clinical trials are now under way to test new treatments for this stage of the disease.
Stage III : -The cancer has spread into tissues around the adrenal gland or has spread to the lymph nodes around the adrenal gland. Lymph nodes are part of the lymphatic system and are small, bean-shaped organs that make and store infection-fighting cells.
During this stage, treatments may be one of the following : -
Surgery to remove the cancer. Lymph nodes in the area may also be removed (lymph node dissection).
A clinical trial involving radiation therapy.
A clinical trial involving chemotherapy if the size of the tumor can be measured with x-rays and/or if the tumor is making hormones.
Stage IV : -The cancer has spread to tissues or organs in the area and to lymph nodes around the adrenal cortex, or the cancer has spread to other parts of the body. During this stage, treatments may be one of the following : -
A clinical trial involving chemotherapy.
Radiation therapy to bones where the cancer has spread.
Surgery to remove the cancer in places where it has spread.
Recurrent : - The cancer has come back (recurred) after it has been treated. It may come back in the adrenal cortex or in another part of the body. Treatment during this stage depends on many factors, including where the cancer came back and what treatment has already been received. In some cases, surgery can be effective in decreasing the symptoms of the disease by removing some of the tumor. Also, clinical trials are currently testing new treatments for this stage of the disease.
Treatment Options
There are three primary treatment options for patients with cancer of the adrenal cortex : -
Surgery : -
Surgery is local therapy to remove the tumor. Tissues around the tumor and nearby lymph nodes may also be removed during the operation. When treating cancer of the adrenal cortex, a doctor may take out the adrenal gland in an operation called an adrenalectomy. Tissues around the adrenal glands that contain cancer may also be removed. Lymph nodes in the area may be removed as well (lymph node dissection).
Chemotherapy : -
Chemotherapy is treatment with drugs that kill cancer cells. Most anticancer drugs are injected into a vein or muscle; some are given by mouth. Chemotherapy is a systemic treatment, meaning that the drugs flow through the bloodstream to nearly every part of the body to kill cancerous cells. It is generally given in cycles; a treatment period is followed by a recovery period, then another treatment period, and so on.
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Radiation Therapy (also called radiotherapy) : -
Radiation therapy is treatment with high-energy rays that damage cancer cells and stop them from growing and dividing. It is a local therapy that only affects cancer cells in the treated area. Radiation may come from a machine (external radiation) or from an implant placed directly into or near a tumor (internal radiation). External radiation is typically the method used for cancer of the adrenal cortex. Besides treatment for the cancer itself, a patient with cancer of the adrenal cortex may also receive therapy to prevent or treat symptoms caused by the extra hormones that are made by the cancer.
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Treatment Side Effects
Side effects can occur with cancer treatments because the treatment often damages healthy cells along with the cancer cells. The type and extent of these side effects vary depending on the particular treatment involved, its duration, and its dose:
Surgery : -
The side effects of surgery depend on the location of the tumor and the type of operation, among other factors. Although patients are often uncomfortable during the first few days after surgery, this pain can usually be controlled with medicine. The recovery period after an operation varies from patient to patient.
Chemotherapy : -
Chemotherapy drugs generally target rapidly dividing cancer cells. However, other cells that also divide rapidly include blood cells, cells that line the digestive tract, and cells in hair follicles. Unfortunately, these healthy cells may also be affected by the chemotherapy drugs, resulting in side effects such as infections, tiredness, temporary hair loss, and mouth sores. Not all chemotherapy patients develop all of these symptoms, and they usually go away during the recovery period or after treatment stops. Medicines and other treatments are available to control or minimize many of these symptoms.
One of the most important side effects of many chemotherapy drugs is lowering of the blood counts. Because chemotherapy can reduce the function of the bone marrow, where most blood cells are produced, it can cause:
anemia (you may have less energy).
low platelets (you may bruise or bleed easily).
low antibodies (you may be more susceptible to infections).
Radiation Therapy : -
The most common side effects of radiation therapy are tiredness, skin reactions in the treated areas (such as a rash or redness), and loss of appetite. Radiation therapy may also cause a decrease in the number of white blood cells that help protect the body against infection. Most of these side effects can be treated or controlled and in most cases they are not permanent.
During cancer treatment, patients may lose their appetite and find it hard to eat well. In addition, the common side effects of treatment (nausea, vomiting, and mouth sores) can make it difficult to eat. To some patients, foods taste different. Others may not feel like eating when they are uncomfortable or tired.
Eating well means getting enough calories and protein to help prevent weight loss and regain strength. Patients who eat well during cancer treatment often feel better and have more energy. In addition, they may be better able to handle the side effects of treatment.
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