Treatment of adrenal cancer abroad
Adrenal cancer is a rare but aggressive malignant oncologic pathology with a tumour arising from the adrenal cortex. People of all ages, including children, have an underlying risk for this illness.
The tumour leads to death within several years after the diagnosis. General 5-year-survival rate of patients doesn’t exceed 40% even in developed countries.
Causes of adrenal cancer
85% of adrenal cancer cases occur sporadically and are not associated to a genetic predisposition or syndromes. However, the other 15% are associated to the various defects of the genetic material.
There are basic syndromes causing adrenal cancer in these cases:
- Li-Fraumeni syndrome
- Multiple endocrine neoplasia
- Beckwith-wiedemann syndrome
- Family adenomatous polyposis
- Hereditary nonpolyposis colorectal cancer
Currently, no certain facts exist about any risk factors from an environmental impact. Limited tests show that smoking contributes to the development of the pathological process, but this hasn’t been proven for sure.
Symptoms of adrenal cancer
All the adrenal cancer symptoms are triggered either by the tumour growth and its compression of the surrounding tissues or by the excessive hormone secretion.
Symptoms cause the excessive secretion of reproductive hormones
Cancerous process can cause the intensified testosterone production. This will be especially visible in kids that have early hair growth on the body and face. This is followed by a change in the voice tone. Symptoms in boys include increased growth of the penis beyond his average age. In girls this can be increased growth of the clitoris.
Increased secretion of oestrogen during childhood advances the early sexual maturation of girls. They experience early menstruation and growth of their breasts. High oestrogen level causes gynaecomastia in boys which is enlarged breasts similar female breasts.
It is noteworthy that the adrenal cancer symptom of hyper production of sex hormones are poorly expressed in adult patients. Nevertheless, clinical signs become visible when male hormones prevail in women and vice versa. Thus, women might notice bald patches, irregular menstruation cycles, rough voice, and facial hair growth. The symptoms in men are found when their breasts start enlarging, their erection worsens and libido decreases.
Symptoms causes by excessive cortical production.
Hyper secretion of cortisone may result in the Cushing's syndrome.
The following symptoms are peculiar for this type:
- Fat deposits on the neck and shoulders
- The appearance of violet stretch marks on the abdomen
- Osteoporosis (reduction of bone mass) and pathological fractures
- Excessive growth of hair on the face and chest areas
- Loss of leg muscle mass
- Bruising even during the slightest touch to the body
- Frequent mood swings, depression
- High blood pressure
- High blood sugar
- Irregular menstrual cycles in females
It is not necessarily that all the symptoms should be present as even 2 or 3 of those described above can infer the increased cortisone blood level.
Symptoms caused by excessive production of aldosterone.
In rare cases, the formation of a malignant aldosteron-producing tumour of the adrenal gland is possible.
In this case, such symptoms can appear:
- High blood pressure
- Muscle weakness
- Muscle cramps
- Low level of potassium in the blood
Symptoms causes compression of the surrounding tissue with a tumour.
Large sized adrenal gland tumour usually indicates an advanced stage of the oncological process. In this case, there is pain and a foreign body sensation in the abdomen. Food passing is obstructed due to stomach compression. As a consequence, a patient is losing weight and feels full while eating a small amount of food.
Diagnostics of adrenal cancer
Specialists need to assess the symptoms and then prescribe lab tests for hormones to check their blood levels. However, these changes cannot confirm the presence of cancer in the patient. The majority of hormone producing adrenal tumour cases are benign.
Visualization techniques are used to detect a tumour-like adrenal formation to either suspect or exclude the cancer:
- Computed tomography
- Ultrasound is usually done if there is no way to use a CT
- MRI with contrast helps to differentiate between adrenal cancer and benign tumours
- PET is done to detect metastases
Fine needle and puncture biopsy of the tumour is rarely prescribed as cancer can spread tumour cells to the other organs. Thus, histology is performed during the surgery. A doctor removes malformation and if it appears to be malignant he expands the volume ofsurgey.
Doctors can do laparoscopy as well to evaluate the prevalence of the ongoing process. The procedure is done with the help of a tube and a tiny video camera at the end of it where you can see the distant metastases, enlarged regional lymph nodes and plan for the extent of the future surgery.
Treatment of adrenal cancer abroad
Surgical intervention is a common form of therapy. The extent of surgery can be of different depending on the size and location of the tumour.
Cancer may grow into the different organs such as the:
- Muscle and fat tissues
- Inferior vena cava
The affected organ is going to be partially or completely removed together with the lymph nodes. In case of large vessels for e.g, the inferior vena cava, the surgeon must form a bypass to ensure blood access to the heart from a systemic circulation.
Laparoscopy is possible during the first two stages of the onset of adrenal cancer. The damaged organ is removed through the small incisions done by an endoscope and miniature surgical aids that will be administered through the thin tube.
Radiation therapy can be added at each stage of adrenal cancer treatment. Radiation is mandatory from the third stage onwards. Distant kind of radiation is more often applied. Brachytherapy the so called introduction of intracavitary radioactive substances is rarely applied. Radiation therapy is frequently administered postoperatively to reduce the risk of recurrence.
Chemotherapy has poor impact on the adrenal cancer though it is administered in certain cases. It’s used to slow down the tumour growth in case of inoperable cancer.
Innovative treatments of adrenal cancer
Germany is one of the countries where research for the latest, most effective adrenal cancer treatment methods are ongoing. University of Würzburg carries out such research.
The effectiveness of many drugs are tested to define the possibility of their use for adrenal cancer treatment. Unfortunately, the majority of them appear to be ineffective.
Nonetheless, preliminary recent tests results of the following medicines are promising:
- I GF2 inhibitors (insulin-like growth factor 2), Cixutumumab in particular
- Temssirolimus is a protein tyrosine kinase inhibitor
The combination of these medicines help to hinder tumour growth in certain patients within several months during one of the researches.
Prognosis for adrenal cancer
5-year-survival prognosis depending on the prevalence of the pathologic process:
- Localized cancer without metastases – 65%
- Regional cancer when there are metastases in the regional lymph nodes and a tumour grows into the surrounding organs and tissues – 44%
- Spread cancer when there are distant metastases – 7%
Adrenal cancer is peculiar with a negative prognosis mainly, because it is diagnosed too late. Its early stage is asymptomatic and screening diagnostic methods are absent as this type of cancer is rare.