Adrenal Cancer

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Questions to Ask Your Doctor About Your Cancer
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Treatment

Treatment for adrenal cancer depends on the stage of the disease at diagnosis. Options include surgery, chemotherapy, and radiation. Treatment for patients with functioning tumors usually involves using medications to manage symptoms.

Pheochromocytomas require treatment before surgery (neoadjuvant treatment) for high blood pressure, which often includes alpha-blockers (e.g., phenoxybenzamine, prazosin) followed by beta-blockers (e.g., propranolol), and metyrosine.

Surgery

Surgical removal of the adrenal gland (called adrenalectomy) is the only cure for adrenal cancer. It is important to determine if the cancer has spread before surgery, because metastases to lymph nodes or other organs (e.g., liver, lungs, kidneys) often requires extensive surgery. Adrenal tumors that have not spread are sometimes removed using laparoscopic adrenalectomy, which is performed through a smaller incision.

Chemotherapy

Chemotherapy is a treatment that travels throughout the body via the bloodstream (called a systemic treatment) that often uses a combination of drugs to destroy cancer cells. It is used as a palliative treatment for metastatic adrenal cancer and may also be used in addition to surgery (adjuvant therapy). Drugs may be administered orally or through a vein (intravenously).

Mitotane (Lysodren®) suppresses adrenal gland function and is the drug of choice to treat inoperable adrenal cancer. Approximately 20% of adrenal cancer patients respond to treatment with mitotane. Side effects include gastrointestinal disturbances (e.g., loss of appetite, nausea, vomiting, diarrhea) and neurological disturbances (e.g., depression, lethargy, sleepiness).

When mitotane therapy fails, cisplatin (Platinol®) may be tried, alone or combined with other agents. Drug combinations used include the following:

• Cyclophosphamide (Cytoxin®, Neosar®), doxorubicin (Adriamycin®), cisplatin
  
• Fluorouracil (Adrucil®, Efudex®), doxorubicin, cisplatin
  
• Cisplatin with VP-16
  

Neuroblastoma may be treated with chemotherapy in addition to surgery (adjuvant therapy) using carboplatin (Paraplatin®), cyclophosphamide, doxorubicin, and etoposide (Vepesid®).

Side effects of chemotherapy are often severe and include gastrointestinal disturbances, low blood count (anemia), skin disorders, and neurological disorders.

Radiation Therapy

Radiation therapy uses high energy x-rays to destroy cancer cells. Radiation is not used as a primary treatment for adrenal cancer. It is sometimes used as a pain relieving (palliative) treatment for metastatic adrenal cancer.

Medical Management of Functioning Tumors

Treatment for patients with functioning tumors includes managing symptoms caused by increased hormone production.

Increased cortisol production (Cushing's syndrome) is often treated with aminoglutethimide or ketoconazole (Nizoral®) to inhibit cortisol build-up (synthesis). They may be used alone, or in combination with chemotherapy. Side effects include nausea, vomiting, and abdominal pain.

Excess aldosterone production (Conn's syndrome) is usually treated using spironolactone (Aldactone®). Spironolactone is an aldosterone antagonist (i.e., counteracts the action of aldosterone). Side effects include ulcers, abnormal breast enlargement in men (gynecomastia), fever, and headache.

Aromatase inhibitors such as anastrozole (Arimidex®) and anti-androgens such as bicalutamide (Casodex®) may be used to treat excessive androgen production.

Prognosis

The prognosis for adrenal cancer depends on the stage of the disease. Metastatic tumors have a poor prognosis. The 5-year survival rate when surgical removal of the cancer is achieved is approximately 40%. About 80% of cases recur within 10 years after treatment.

Prevention

Adrenal cancer cannot be prevented.

Adrenal Cancer, Treatment reprinted with permission from urologychannel.com
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