Adrenal cancer tumor

Adrenal Gland Tumor

About the Adrenal Glands:

Every person has two adrenal glands, one located on top of each kidney. These glands are small, yellowish, and weigh about 10 grams each. The adrenal glands are crucial components of the body’s hormonal system. Each adrenal gland has two parts based on its function:

1. Adrenal Cortex: The outer layer of the adrenal gland, which produces three hormones: Cortisol, Aldosterone, and Dehydroepiandrosterone (DHEA). These hormones regulate metabolism, blood pressure, hair growth, and body shape.
2. Adrenal Medulla: The inner part of the adrenal gland, which produces three hormones: Epinephrine, Norepinephrine, and Dopamine. These hormones are responsible for how the body responds to stress.

What is an Adrenal Gland Tumor?

An adrenal gland tumor occurs when cells in the adrenal gland grow uncontrollably, forming a mass. This tumor can either be benign (non-cancerous) or malignant (cancerous). Since the adrenal gland produces hormones, some tumors may produce excess hormones, known as functioning tumors. Tumors that do not produce hormones are called non-functioning tumors.

Types of Adrenal Gland Tumors:

1. Adenoma: The most common type of tumor found in the adrenal gland. It is a non-cancerous growth in the adrenal cortex and can be either functioning or non-functioning. Treatment is only required if the tumor is producing excess hormones.
2. Adrenocortical Carcinoma: A rare cancerous tumor that grows in the adrenal cortex. It can be functioning or non-functioning.
3. Neuroblastoma: A cancer that develops in the adrenal medulla, mostly found in children.
4. Pheochromocytoma: A neuroendocrine tumor that grows in the adrenal medulla. It can cause symptoms such as high blood pressure, rapid heart rate, and excessive sweating.

Statistics:

Adrenal gland tumors are rare, and there is no specific data available for India. In the United States, approximately 600 cases of Adrenocortical Carcinoma are diagnosed each year.

Risk Factors:

Some genetic conditions increase the risk of adrenal tumors. These include:

• Multiple Endocrine Neoplasia Type 2 (MEN 2)
• Li-Fraumeni Syndrome
• Von Hippel-Lindau Syndrome
• Neurofibromatosis Type 1
• Carney Complex
• Succinate Dehydrogenase Mutations

No other specific risk factors for adrenal cancer have been proven yet.

Symptoms:

Common symptoms of adrenal gland tumors include:

• High blood pressure
• Low potassium levels
• Heart palpitations
• Anxiety
• Headaches
• Excessive sweating
• Diabetes
• Abdominal pain
• Unexplained weight gain or loss
• Fatigue
• Stretch marks on the abdomen
• Excessive hair growth
• Changes in the genital organs
• Abnormal acne

Diagnosis:

1. Blood and Urine Tests: These tests measure hormone levels to determine if the tumor is functioning (producing excess hormones) or non-functioning.
2. Biopsy: A biopsy can be done in two ways:
• FNAC (Fine Needle Aspiration Cytology): A needle is used to extract cells and fluids from the tumor.
• Surgical Biopsy: A small part of the suspected tumor is surgically removed for examination.
3. CT Scan: A detailed imaging test to determine the size and spread of the tumor.
4. MRI: Magnetic resonance imaging helps provide detailed images of the adrenal glands.
5. MIBG Scan: A specialized imaging test used to detect neuroendocrine tumors.
6. Adrenal Vein Sampling: A procedure to measure hormone levels directly from the adrenal veins.
7. PET-CT: A combined PET and CT scan to assess the tumor and possible spread.

Stages of Adrenal Gland Tumors:

Tumor Size:

• TX: The primary tumor cannot be evaluated.
• T0: No evidence of a primary tumor.
• T1: The tumor is less than 5 cm in size and has not spread outside the adrenal gland.
• T2: The tumor is larger than 5 cm but has not spread outside the adrenal gland.
• T3: The tumor can be of any size and has spread just beyond the adrenal gland but not to nearby organs.
• T4: The tumor has spread to other organs, muscles, or nerves regardless of size.

Node Involvement:

• NX: Lymph nodes cannot be evaluated.
• N0: No spread to the lymph nodes.
• N1: Cancer has spread to the lymph nodes.

Metastasis:

• M0: No spread to distant parts of the body.
• M1: Cancer has spread to distant parts of the body.

Treatment for Adrenal Gland Tumors:

1. Surgery:
• If the tumor is small and there are no signs of cancer, laparoscopic surgery may be performed. This minimally invasive surgery involves small incisions and the use of a camera and light for tumor removal.
• If the tumor is large or cancerous, open surgery may be required to remove the tumor.
2. Hormone Therapy:
• Since the adrenal gland produces hormones, medication may be needed to control hormone levels.
3. Chemotherapy:
• The drug Mitotane (Lysodren) is commonly used to treat adrenal cortex cancers.
4. Radiation Therapy:
• Radiation may be used in certain cases to destroy cancer cells remaining after surgery.

Follow-up for Adrenal Gland Tumor:

After treatment, regular follow-up tests are essential to monitor for cancer recurrence and manage side effects. Follow-up care includes routine physical examinations, blood tests, and imaging scans to ensure the cancer does not return.

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