This information is an interpretation of various studies that have been published in medical journals. The information below represents various views of nurses and doctors who serve on the American Cancer Society’s Cancer Information Database Editorial Board. Keep in mind that the information provided in this article is not designed to be taken as medical advice or to replace the opinion and judgment of your personal cancer care team. It is simply designed to help you make informed decisions together with your doctor.
The general treatment options that will be discussed may not be what your doctor recommends, and there may be various reasons why. You should take the time to find out what specific treatments doctors recommend for you.
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The primary treatment for adrenal cancer is surgery. The adrenal gland will be completely removed if it is no longer possible to remove the tumor itself. This may necessitate a lifetime need to supplement hormones after the surgery, especially if both adrenal glands are removed.
The surgery to remove the adrenal glands is called adrenalectomy. The goal is to remove as much of the adrenal cancer as possible, including enlarged lymph nodes that could contain cancer spread. One approach is through an incision in the back below the ribs, which works well for small tumors. More often, the incision is made through the front of the abdomen for better visibility and access to large tumors or those invading other organs like the kidney, which may also need partial or complete removal. If the cancer has invaded the inferior vena cava, extensive surgery may be needed, possibly requiring a heart-lung bypass pump. For liver invasion, the involved part of the liver may require removal.
Laparoscopic surgery through small incisions using a camera and instruments can be used to remove some small adrenal tumors. This minimally invasive approach has faster recovery times. However, laparoscopy may not be suitable for larger cancers or those extending into surrounding tissues, which are difficult to remove completely in small pieces through the laparoscope.
Surgery aims to remove the entire tumor whenever possible. All enlarged lymph nodes and invaded surrounding tissues must also be removed for complete resection. The surgical approach depends on tumor size and extent of local invasion, with open incisions preferred for larger cancers to avoid fragmentation and spread of the tumor.
Radiation therapy is not the main treatment for adrenal cancer. It may be used as ‘adjuvant therapy’ to keep the cancer from coming back after surgery, or when the cancer has spread outside the adrenal glands.
There are 2 main types of radiation therapy:
External beam radiation therapy directs radiation on the cancer from a machine outside the body. Treatments are often given once or twice a day, 5 days a week for several weeks. The treatment itself is not painful and can be likened to getting an extended x-ray. The actual treatment time is only a few minutes, although setup takes longer to accurately aim the radiation at the cancer. Planning sessions called simulation are necessary before radiation therapy and usually include imaging tests like CT or MRI scans to determine proper angles.
Brachytherapy (internal radiation therapy) uses small radioactive pellets placed next to or into the cancer, sometimes in thin plastic tubes. The tubes with pellets stay in place for a few days to saturate the cancer with radiation and kill it off without extensively irradiating the surrounding organs. Higher doses of radiation may be used, in which case the time the pellets stay in the body will be shortened. Brachytherapy is not commonly used for adrenal cancer.
Common side effects of radiation therapy may include nausea, vomiting, diarrhea if the abdomen is treated, skin changes from redness to blistering and peeling, hair loss, fatigue, and reduced immunity due to low blood counts.
Chemotherapy involves the use of specific anti-cancer drugs, usually given through an IV infusion or via pills, which can reach further into the body and kill off cancer cells that may have spread. Chemo is also not the primary treatment for adrenal cancer, but if it has metastasized, it may be employed.
Mitotane is the most commonly used drug for adrenal cancer. It blocks hormone production and destroys adrenal cancer cells, but also kills healthy adrenal tissue. This can lead to low hormone levels, causing weakness, sickness, and depression. If this happens, steroid hormones are administered to restore adequate levels. Mitotane can also affect thyroid and testosterone levels, requiring replacement hormones. Sometimes mitotane is given after surgery to kill any remaining cancer cells. This adjuvant therapy may prevent or delay cancer from returning. If cancer remains after surgery or returns, mitotane shrinks tumors in some patients, working for as much as a year on average. It is particularly helpful for excess hormone problems, even if it doesn't shrink the tumor, because it can reduce abnormal hormone production and relieve symptoms.
Mitotane can cause major side effects like nausea, vomiting, diarrhea, rashes, confusion, and sleepiness. However, lower doses can still be effective with fewer side effects. This pill is taken 3-4 times daily and needs close monitoring and supervision.
Other drugs used for adrenal cancer chemotherapy:
Chemotherapy drugs are given in cycles and there are mandatory rest periods in between because they are potent and can deteriorate the body, even killing normal cells. The following side effects may be expected:
Drugs that lower adrenal steroid hormone production like Ketoconazole and metyrapone can be used to relieve symptoms. Hormone blockers like the ones below may also be used:
If you or a loved one have suffered from a misdiagnosis or delayed diagnosis for your adrenal cancer, or from negligence that caused more harm during your treatment, contact us at 833-PORTER9, or e-mail us at info@porterlawteam.com to discuss the details of our experience representing other clients and the results we were able to obtain in the past for clients who are suffering as you are.
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