Since the adrenal gland is an organ of the endocrine system that synthesizes many vital hormones, adrenal tumors, consisting of secreting cells, can seriously affect the well-being of the person and even lead to dangerous conditions, such as hypertensive crisis. Therefore, it is important that when characteristic symptoms appear, the doctor promptly suspects that the cause of the malaise can be a neoplasm of the adrenal gland.
Early symptoms include abdominal or back pain, unexplained weight loss, hormonal changes such as high blood pressure, excessive hair growth or irregular menstrual periods, and abdominal bloating due to a tumor.
Diagnosis involves a review of the medical history, physical examination, imaging tests such as CT scans or MRI.
Treatment options may include surgery to remove the tumor and affected adrenal gland, chemotherapy, radiation therapy, targeted therapy, and sometimes hormone therapy.
The prognosis depends on factors such as the stage of the cancer and the response to treatment. In some cases, a complete cure is possible with early detection and proper treatment.
Risk factors include genetic conditions such as Li-Fraumeni syndrome or Beckwith-Wiedemann syndrome, certain inherited genetic mutations, and exposure to certain toxins or radiation.
Types of adrenal tumors
Despite their small size (about the size of a chestnut), the adrenal glands have a complex structure. They consist of the cortex and the medulla, which synthesize hormones with different functions.
Adrenal tumors are most often benign: this means that they consist of normal cells that divide faster than usual. Such neoplasms do not metastasize and do not invade surrounding organs, but can nevertheless harm the patient because they increase the content of a particular hormone in the blood. For example, aldosteronomas disrupt water-salt metabolism, leading to high blood pressure, headaches, thirst, frequent urination, and other symptoms.
One of the most dangerous benign tumors of the adrenal gland is pheochromocytoma, which arises from chromaffin cells. Pathological increase in the concentration of adrenaline in the blood leads to sudden rises in blood pressure, attacks of fear and chills, increased heart rate, and acute headaches. Recurrent exacerbations can significantly weaken the patient or even endanger their life, so such adrenal tumors need urgent treatment.
Malignant tumors of the adrenal gland, such as adrenocortical cancer, are much less common. Sometimes the diagnosis is made only after histological analysis of the tissue after surgery when a recurrence occurs or metastases are found after treatment has been completed.
Signs of adrenal cancer
Adrenal cancer may not manifest itself in any way. In such cases, the adrenal tumors are found accidentally during an examination for another reason. Such a mass is not always malignant. Autopsies of deceased people from various causes found adrenal tumors in one in fifteen adults, with many of formations being quite large, over 6 cm, and one-fourth of them being malignant, with no manifestations during life.
The most striking manifestation of adrenal cancer is Cushing syndrome, which is diagnosed by the appearance of the patient only. A barrel-shaped torso with a visually large neck is formed by an excess of irregularly arranged fat, with the arms and legs remaining thin. The masculine appearance of women with hair growth not in the peculiar places, and hair loss on the head is quite typical for the syndrome. Such patients have the diagnosis of diabetes and arterial hypertension, which occurred exclusively against the background of excessive production of hormones. Symptomatology is not always pronounced, but to some extent some symptoms of adrenal cancer are present.
The second clinical variant is a virile syndrome with hyperproduction of the sex hormone androgen. For female patients, the diagnosis implies clinically tested elevated androgen levels, acne, increased sex drive, hair loss on the head, and excessive hair growth in the other places of the body. In men, on the contrary, the diagnosis causes excessive estrogen production, loss of muscle strength, and decreased potency.
A hormonally active tumor of the adrenal gland changes the hormone production of the opposite healthy adrenal gland, while it becomes functionally weaker and gradually atrophies. If one adrenal gland produces a lot, the other automatically reduces its hormonal activity, and inactivity of the adrenal gland leads to excessive growth of connective tissue in it. After removal of the adrenal gland affected by adrenal cancer, the remaining adrenal gland does not perform its functions due to atrophy. This causes an extremely life-threatening situation, which, however, can be easily prevented in advance if one knows the possibilities of the remaining paired organ.
Treatment tactics
For the treatment of adrenal cancer, a comprehensive approach is used, which often involves surgical cancer removal along with the gland and the nearest lymph nodes, as well as subsequent chemotherapy and radiation therapy with the introduction of radioactive isotopes. Surgery is also indicated for cases of relapse of adrenal cancer, and removal of metastases (suitable for intervention). Doctors are very balanced in their decision about surgery, since removing an adrenal tumor is a complicated procedure with a high risk of complications.
Sometimes chemotherapy and radiation therapy are used before surgery to reduce the size of the tumor. To reduce the toxic effects, adjuvant chemotherapy may be prescribed, in which the active substance accumulates in the area of pathological cell overgrowth.
Depending on the hormonal status of the adrenal tumors, hormone therapy may be used.
Symptomatic and palliative treatment is indicated for inoperable tumors, detection of adrenal cancer beyond the stage one-three, and the presence of distant metastases.
After surgical treatment, chemotherapy, or radiation therapy, during the recovery period and further, during the whole life, the patients should be under the supervision of an endocrinologist and oncologist.
Peculiarities of surgery
And again, the treatment tactic depends on the type of tumor process and the degree of its progression. In any case, treatment measures are planned individually for each patient.
The most effective method of treating adrenal cancer at stage 1-3 is still the surgical removal of the affected organ.
Surgery to remove the adrenal gland needs careful preparation. The data obtained after several types of examinations allows doctors to understand what cells the tumor is formed of. Also, the examination shows exactly where it is localized, whether it is hormonal activity, and what size it has.
To properly prepare for surgery, a person is prescribed laboratory blood and urine tests. They are needed to determine if there are any contraindications for the intervention such as acute infectious and inflammatory processes in the body. The surgeon and anesthesiologist also consult with the patient to outline a preliminary plan of action during the operation and select the appropriate anesthesia drugs.
Surgery that removes a neoplasm in the adrenal gland and the organ itself is very complex and requires a highly qualified surgeon. When performing the surgical intervention, it is necessary to mobilize precisely the adrenal gland and correctly isolate its vascular system, without damaging large vessels and nearby organs.
Doctors at European hospitals perform such an intervention using the laparoscopic method, which has significant advantages over the conventional laparotomic access. Laparoscopy is carried out with minimal traumatism, as access is made through punctures in the abdomen. A laparoscope with a built-in miniature camera is inserted through one of the punctures. It allows surgeons to monitor the operation through broadcasting every step on the monitor in real-time.
Avoiding the incision promotes less tissue trauma and prevents infectious complications. Laparoscopy does not require the placement of drains, reduces blood loss and pain syndrome. The healing process after laparoscopy takes place several times faster than in case of open surgery. At the same time, modern equipment allows performing some manipulations that are not typical for traditional surgery. This refers to organ-preserving surgery for adrenal tumors.
A serious problem in adrenal tumor removal is the body's unpredictable response to changes in hormone levels. Right in the course of surgery, a patient with a pheochromocytoma (neuroendocrine tumor) can develop a severe circulatory disorder. That is why it is so important that the intervention is performed by surgeons and anesthesiologists with extensive experience in managing such patients.
To ensure a complete cure, the entire adrenal gland with the tumor located there is usually removed during the operation. The function of hormone production is assumed to be taken over by the paired organ. Sometimes it cannot cope with the load, and then the endocrinologist prescribes the patient hormone therapy in the postoperative period. This type of therapy allows avoiding problems with health.
Conservative treatment options
Aside from surgery, treatment options come down to radiation therapy, chemotherapy, and hormone therapy.
Radiation therapy can be used as an independent or auxiliary (to destroy malignant cells after surgery) method of treatment. In the case of metastatic adrenal cancer, doctors irradiate the lymph nodes that are in close proximity to the adrenal gland affected by cancer. Thanks to the fact that European hospitals use advanced devices for radiotherapy, adrenal tumors are irradiated without affecting surrounding healthy tissue.
Brachytherapy, as a method of contact irradiation, with radiation exposure applied directly to the tumor center, can be used as well. Brachytherapy has proven highly effective in adrenal cancer treatment, helping reduce the size of the tumor significantly and prevent its metastasis.
Chemotherapy helps to reduce the size of the malignant neoplasm and prevent the development of metastases. Chemotherapy is most often used as part of complex treatment (before or after surgery, in combination with radiation therapy). It can also be used to reduce the levels of hormones produced by the adrenal glands in inoperable neoplasms.
Patients with abnormal hormone levels caused by the presence of adrenal cancer or cancer treatment may benefit from hormone control and hormone therapy. They may be prescribed medications to correct some of the symptoms of a hormone imbalance caused by the presence of hormonally active cancer or to restore hormone levels altered by tumor growth or other treatments.
After removal of the adrenal gland and/or treatment with chemotherapy that affects hormone production, patients may require hormone replacement therapy. Low levels of adrenal hormones can cause many problems, including dysregulation of blood pressure and blood sugar concentration. Adrenocortical carcinoma, for example, is a very rare cancer in children, but children with this disease need constant monitoring of hormone levels to detect recurrence.
Adrenal cancer is a complex disease, the treatment of which requires the involvement of a multidisciplinary team that includes specialists in pediatric oncology (if the child is treated), diagnostic imaging, surgery, pathological anatomy, radiation oncology, endocrinology, and genetic counseling.
The cost of treatment in European hospitals
Adrenal cancer might be characterized by rapid progression and metastasis (when cancer has spread), after which the adrenal cancer cells penetrate to other healthy organs. This pathology is not that common in clinical practice, and not all medical centers know how to treat it. For someone with adrenal cancer, diagnosis and treatment in Europe is the best solution to the problem. The doctors working in European hospitals have extensive experience in the therapy of rare cases of cancer. Comprehensive diagnostics and adrenal cancer treatment, the latest surgical developments, and innovative conservative methods, combined with close monitoring of long-term results and consultation of patients in European hospitals, are the key to recovery and return to full life after treatment in Europe.
As for the cost of treatment in Europe, it depends on the prices for medical procedures chosen for adrenal cancer treatment. Treatment options will depend on the tumor grade, its localization, singularity or multiplicity of spread cells (if any), growth rate, and influence on the hormone production, which you will discuss in detail with your doctor.
The cost of treatment in Europe with surgery for adrenal cancer starts at 9,065 EUR; the cost of treatment of adrenal cancer with chemotherapy starts at 1,985 EUR; the minimal price for diagnostics starts at 781 EUR.
If you would like to establish what the price for adrenal cancer treatment is going to be for you, contact Booking Health.
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Authors:
The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova and Dr. Vadim Zhiliuk. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
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Sources:
National Library of Medicine
American Cancer Society
Annals of oncology
