Adrenal Cancer

Adrenal cancer is an uncommon malignancy affecting the adrenal glands, two small glands located on top of each kidney. Certain types of this cancer can rapidly spread to other parts of the body. It tends to impact hormone production, leading to symptoms such as fluid retention, weight gain, increased facial hair, and early-onset puberty in children. Treatment typically includes surgical removal of the tumors, along with radiation therapy and chemotherapy. Common medications used in its management are adrenal cytotoxic agents like Lysodren and catecholamine synthesis inhibitors such as Demser.

Causes

Adrenal cancer originates from DNA mutations within the adrenal gland cells, resulting in uncontrolled cell growth. The exact reasons for these mutations are still not fully understood. However, genetics plays a significant role, with conditions such as Beckwith-Wiedemann syndrome, Li-Fraumeni syndrome, and Lynch syndrome linked to a higher risk. Although environmental influences like smoking and exposure to certain chemicals have been considered, genetic factors are more prominently associated with the development of adrenal cancer. In short, inherited genetic predispositions tend to outweigh environmental contributors in the causation of adrenal cancer.

Symptoms

Adrenal cancer is rare and may present several noticeable symptoms. Patients might experience pain, especially in the back or abdominal area, unintentional weight loss, and a reduced appetite. Hormonal imbalances can lead to Cushing syndrome, with symptoms such as weight gain, muscle weakness, high blood pressure, and high blood sugar. Overproduction of sex hormones could cause unusual facial hair growth in women or hair thinning on the scalp, and men may notice enlarged breast tissue. If aldosterone is produced excessively, it can lead to elevated blood pressure and reduced potassium levels. Early recognition of these symptoms and consulting a healthcare professional is crucial for appropriate care and management.

Diagnosis

Diagnosing adrenal cancer involves a thorough assessment of the patient’s symptoms and medical history, coupled with a physical examination. Blood and urine tests are pivotal in detecting abnormal hormone levels like cortisol and androgens, potentially indicating an adrenal gland imbalance. Imaging tests such as CT scans, MRIs, and PET scans produce detailed images of the adrenal glands, helping to identify tumors and assess the cancer’s spread. An adrenalectomy, a surgical procedure to remove the adrenal gland, may be performed in some cases to allow a pathologist to examine it for cancerous cells under a microscope. Early and accurate diagnosis is essential for effective treatment and outcomes.

Treatments

Surgery, specifically adrenalectomy—the removal of the adrenal gland—is the cornerstone of adrenal cancer treatment. This procedure confirms the diagnosis, removes the tumor, and addresses symptoms of excessive hormone production. If the cancer has spread, the surgery might also involve adjacent organs to ensure comprehensive treatment. Post-surgery, radiation therapy may be used to eradicate remaining cancer cells and alleviate symptoms, especially if the cancer has metastasized. Chemotherapy, with drugs such as Mitotane, is often reserved for advanced stages, helping to control cancer progression when surgery isn’t sufficient. Immunotherapy may be considered when cancer continues to spread or surgery is not feasible, boosting the immune system to better target cancer cells.

Medications

Medications are integral to managing adrenal cancer. Mitotane, a primary chemotherapy drug for this cancer, reduces excess hormone production and targets cancer cells. It is taken orally and is beneficial when surgical removal isn't entirely possible or to prevent recurrence. Given its effects on hormone levels, close monitoring and possibly supplemental hormone therapy are necessary. For metastatic adrenal cancer, additional chemotherapy drugs like doxorubicin, Cisplatin, and Etoposide might be used intravenously, typically as part of a comprehensive treatment plan. Chemotherapy can lead to side effects such as nausea, vomiting, and fatigue, but treatment adjustments and supportive therapies can aid in managing these side effects and enhance patient comfort.

Prevention

Due to the unclear causes of adrenal cancer, there are no specific prevention guidelines. However, general lifestyle changes can lower overall cancer risks, including: avoiding tobacco, limiting alcohol, maintaining a healthy weight (BMI below 25), engaging in daily physical activity, and consuming a diet rich in fruits and vegetables while limiting processed meats. For those with a family history of genetic conditions associated with adrenal cancer, discussing risk factors with a healthcare professional is wise. This proactive step aids in understanding and managing individual cancer risks.