Adrenocortical Carcinoma Health Article

Clinical staging, treatments, and prognosis

Adrenocortical tumors are assigned to one of four stages.

• Stage I tumors have not spread beyond the cortex of the adrenal gland and are less than two in (5cm) in their greatest dimension.
• Stage II tumors have not spread beyond the cortex of the adrenal gland and are more than two inches.
• Stage III tumors have either spread into tissues around the adrenal cortex or they have spread into lymph nodes near the adrenal glands, or both.
• Stage IV tumors have spread to lymph nodes and other organs near the adrenal cortex or to other organs of the body.

A plan for treatment is based on the size and extent of the tumor. Surgical removal of the tumor, radiation and chemotherapy are all used. Method of treatment depends on how large the carcinoma is and whether it has spread to other organs. In some cases the treatment is strictly palliative (provides comfort) and is not expected to halt the course of the cancer. Palliative treatment can include surgery to reduce the size of tumor, as well the pain a large tumor causes by pushing against other organs.

Because adrenocortical carcinoma that metastasizes often moves into the renal (kidney) vein and then, the inferior vena cava, venography or MRI scan prior to surgical removal of all or part of the tumor is important. If the tumor has grown into a vein, a piece of it can be dislodged and become a dangerous object. The piece of tumor begins to move in the blood flow and it is capable of getting stuck in a small blood vessel in the heart or the brain, and causing a stroke.

The drug mitotane gives some good results is slowing tumor growth in certain patients. But the only therapy that provides relief in most patients is the removal of the tumor.

The outlook for individuals with adrenocortical carcinoma depends on the stage of the cancer. Because seven in ten individuals are diagnosed only after the cancer has reached stage III or stage IV the five-year survival rate for all stages is 40%. And for individuals with stage IV carcinoma it is much less, with most patients dying within nine months of diagnosis.

Alternative and complementary therapies

Yoga, biofeedback or other relaxation techniques may help manage pain.

Coping with cancer treatment

Being an active member of the treatment team is important. Premier cancer centers encourage patients to play such a role. A support group can also help.

Clinical trials

The Cancer Information Service at the National Institutes of Health, Bethesda, Md., offers information about clinical trials that are looking for volunteers. The Service offers a toll-free number at 1-800-422-6237.

Prevention

No prevention is known.

Special concerns

The excess production of hormones that indicate functioning tumors in adrenocortical carcinoma can also be symptoms of other conditions. A tumor in the pituitary gland can cause the pituitary to produce too much of the hormone that stimulates the adrenal cortex to make cortical hormones. The symptoms are identical to those for the adrenocortical tumor. A pituitary tumor must sometimes be ruled out when an adrenocortical carcinoma is suspected. Brain scans may be necessary.

Resources

PERIODICALS

Kunieda, K. et al. "Recurrence of giant adrenocortical carcinoma in the contralateral adrenal gland 6 years after surgery." Surgery Today 30 (Mar. 2000):294-7.

Wajchenber, B. L. et al. "Adrenocortical carcinoma: clinical and laboratory observations." Cancer 88 (Feb. 15, 2000):711-36.

Diane M. Calabrese

Biopsy

—Tissue sample is taken from body for examination.

Carcinoma

—A cancer that originates in cells that developed from epithelial tissue, a tissue found on skin and mucosal surfaces.

Computed tomography (CT)

—X rays are aimed at slices of the body (by rotating equipment) and results are assembled with a computer to give a three-dimensional picture of a structure.

Homeostasis

—Self-regulating mechanisms are working, body is in equilibrium, no uncontrolled cell growth.

Hormone

—A chemical released by one organ of the body that affects the activity of another organ.

Inferior vena cava

—The large vein that returns blood from the lower body to the heart.

Lymph nodes

—Part of the lymphatic system, these clusters of tissue help to protect the body from foreign substances, organisms, and cancer cells.

Magnetic resonance imaging (MRI)

—Magnetic fields used to provide images of the internal organs of the body.

Pituitary

—A gland at the base of the brain that produces hormones.

Venography

—Technique used for examining veins for blockage, using a dye to make the vein visible with scans similar to x ray.