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Adrenal Gland Tumor - Introduction

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2016

ON THIS PAGE: You will find some basic information about this type of tumor and the parts of the body they may affect. This is the first page of Cancer.Net’s Guide to Adrenal Gland Tumor. To see other pages, use the menu. Think of that menu as a roadmap to this full guide.

About the adrenal glands

Each person has 2 adrenal glands. One is on top of each kidney. The body has 2 kidneys. The adrenal glands are small, yellowish in color, and normally weigh about 10 grams. These glands are important to the body’s endocrine system. The endocrine system is made up of tissues and organs that produce hormones. Hormones are chemical substances that are carried through the bloodstream to have a specific effect on the activity of other organs or cells in the body.

Each adrenal gland has 2 main parts that function separately:

  • Adrenal cortex. The outer part of the adrenal gland is called the cortex. The adrenal cortex makes 3 main hormones: cortisol, aldosterone, and dehydroepiandrosterone (DHEA). These hormones carefully control metabolism, blood pressure, and body features, such as hair growth and body shape.

  • Adrenal medulla. The inner part of the adrenal glands is called the medulla. The adrenal medulla makes 3 hormones: epinephrine, norepinephrine, and dopamine. These hormones, often called catecholamines, control the body’s responses to stress, including the “fight or flight” adrenaline surge.

About adrenal gland tumors

A tumor begins when healthy cells change and grow out of control, forming a mass. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread.

An adrenal gland tumor can sometimes produce too much of a hormone. When it does, the tumor is called a “functioning tumor.” An adrenal gland tumor that does not produce hormones is called a “nonfunctioning tumor.” The symptoms and treatment of an adrenal gland tumor depend on:

  • Whether the tumor is functioning or nonfunctioning

  • Which hormone(s) is produced in excess

  • Whether the tumor started in the adrenal gland or spread from another organ  

Functional adrenal gland tumors may produce any hormone made in the adrenal gland. In rare cases, they may produce more than 1 hormone. 

This section focuses on primary adrenal gland tumors. A primary adrenal gland tumor starts in an adrenal gland. An adrenal gland tumor may also result from a cancer that began in another organ, such as the lungs, and then spread to the adrenal gland through a process called metastasis. Primary adrenal gland tumors include the following:

  • Adenoma. This is the most common type of adrenal gland tumor. It is a noncancerous, nonfunctioning tumor of the adrenal cortex. An adenoma usually does not cause symptoms and, if it is small, often does not need treatment. Adenoma is also called an adrenocortical adenoma,

  • Adrenocortical carcinoma. Adrenocortical carcinoma is rare. However, it is the most common type of cancerous adrenal gland tumor. It is also known as adrenal cortical carcinoma. Approximately 4 to 12 out of 1 million people develop this type of tumor, which begins in the adrenal cortex. Adrenocortical carcinoma can be a functioning or nonfunctioning tumor. If the tumor is functioning, it may produce more than 1 hormone.

  • Neuroblastoma. This is a type of childhood cancer that can begin in the adrenal medulla. Learn more about childhood neuroblastoma.

  • Pheochromocytoma. This type of neuroendocrine tumor most often begins in the adrenal medulla. Learn more about neuroendocrine tumors.

The next section in this guide is Statistics. It helps explain how many people are diagnosed with this type of tumor and general survival rates. Or, use the menu to choose another section to continue reading this guide.

Adrenal Gland Tumor - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2016

ON THIS PAGE: You will find information about how many people are diagnosed with this type of tumor each year. You will also learn some general information on surviving the disease. Remember, survival rates depend on several factors. To see other pages, use the menu.

A primary adrenal gland tumor is very uncommon. Exact statistics are not available for this type of tumor in the United States.

For adrenal cortical cancer, researchers estimate that about 200 to 500 adults in the United States are diagnosed each year. This type of cancer is much less common than an adrenal adenoma, a benign tumor that is found most commonly in middle-aged and older adults. The average age of a person diagnosed with an adrenal gland tumor is 46. However, these tumors can occur at any age. Women tend to be diagnosed with adrenal gland tumors slightly more often than men.

The 5-year survival rate tells you what percent of people live at least 5 years after the cancer is found. Percent means how many out of 100. The 5-year survival rate of people with an adrenal cortical cancer depends on different factors, including the extent (or stage) of cancer at the time it is diagnosed. Other factors that affect survival include the age of the patient and whether the tumor produces hormones.

It is important to remember that statistics on how many people survive this type of tumor are an estimate. So, your own risk may be different. Doctors cannot say for sure how long anyone will live with an adrenal gland tumor. Talk with your doctor about what to expect with your specific diagnosis. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society (2015) and A Patient’s Guide to Adrenocortical Cancer (2012) from the University of Michigan Comprehensive Cancer Center.

The next section in this guide is Risk Factors. It explains what factors may increase the chance of developing this disease. Or, use the menu to choose another section to continue reading this guide.  

Adrenal Gland Tumor - Risk Factors

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2016

ON THIS PAGE: You will find out more about the factors that increase the chance of developing this type of tumor. To see other pages, use the menu.

A risk factor is anything that increases a person’s chance of developing a tumor. Although risk factors often influence the development of a tumor, most do not directly cause a tumor. Some people with several risk factors never develop a tumor, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

What causes most cancerous adrenal gland tumors is not known. However, people with certain hereditary conditions have a higher risk of developing an adrenal gland tumor. People with a high risk of developing an adrenal gland tumor because of their family history should be examined and evaluated by their doctor every year. Hereditary conditions that raise risk of adrenal gland tumors are:

Researchers continue to look into what factors cause this type of tumor and what people can do to lower their personal risk. There is no proven way to completely prevent this disease, but there may be steps you can take to lower your risk. Talk with your doctor if you have concerns about your personal risk of developing this type of tumor.

The next section in this guide is Symptoms and Signs. It explains what body changes or medical problems this type of tumor can cause. Or, use the menu to choose another section to continue reading this guide.

Adrenal Gland Tumor - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2016

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu.

People with an adrenal gland tumor may experience the following symptoms or signs. Sometimes, people with an adrenal gland tumor do not have any of these changes. Or, the cause of a symptom may be another medical condition that is not a tumor.

  • High blood pressure

  • Low potassium level

  • Heart palpitations

  • Nervousness

  • Feelings of anxiety or panic attacks

  • Headache

  • Excessive perspiration

  • Diabetes

  • Abdominal pain

  • Unexplained weight gain or weight loss

  • Weakness

  • Abdominal stretch marks

  • Excessive hair growth

  • Changes in genitalia

  • Unusual acne

  • Change in libido (sex drive)

In addition, pheochromocytoma may cause dangerous surges of the hormones that regulate blood pressure and the body’s response to stress. A hormonal surge can cause blood pressure to rise very quickly, increasing the risk of a heart attack, stroke, hemorrhage, or sudden death.

If you are concerned about any changes you experience, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem, called a diagnosis.

If a tumor is diagnosed, relieving symptoms remains an important part of medical care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Or, use the menu to choose another section to continue reading this guide.

Adrenal Gland Tumor - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2016

ON THIS PAGE: You will find a list of the common tests, procedures, and scans that doctors can use to find out what’s wrong and identify the cause of the problem. To see other pages, use the menu.

Doctors use many tests to find, or diagnose, a tumor. They also do tests to learn if a tumor is cancerous and if it has spread to another part of the body from where it started. If this happens, it is called metastasis. Some tests may also determine which treatments may be the most effective.

To diagnose an adrenal gland tumor, blood and urine tests (see below) look for the presence of certain substances to help determine whether the tumor is functional or nonfunctional. A computed tomography (CT or CAT) scan or a magnetic resonance imaging (MRI) scan (see below) may be useful in making a diagnosis and evaluating whether an adrenal gland tumor is cancerous. Imaging tests may also be used to find out whether a cancerous tumor has spread. Imaging tests show pictures of the inside of the body. Doctors may also do tests to learn which treatments could work best.

This list describes options for diagnosing this type of tumor, and not all tests listed will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • The type of tumor suspected

  • Your signs and symptoms

  • Your age and medical condition

  • The results of earlier medical tests

In addition to a thorough physical examination, the following tests may be used to diagnose an adrenal gland tumor:

  • Blood and urine tests. Blood and urine tests help measure the amount of adrenal hormones, which can detect a functional tumor. A 24-hour urine sample may also be needed. This test requires a person to collect all of his or her urine for an entire 24-hour period, so it can be used for laboratory testing. The test results help the doctor track how quickly various hormones are produced.

    One specific hormone doctors look for with these tests is the stress hormone cortisol. A specific test, called a dexamethasone-suppression test, checks your cortisol levels. For this test, you may be asked to take a pill the evening before. This pill contains a drug that acts like cortisol in the body. When someone who does not have an adrenal gland tumor takes this drug, his or her body will make less cortisol and other hormones. However, if someone has an adrenal gland tumor, cortisol levels will remain high even after taking the drug. Tell your doctor about any medications that you take, even over-the-counter drugs, vitamins, and herbal medications, because this information is needed to correctly interpret the results.

  • Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. If the doctor suspects that cancer has spread to the adrenal gland from another part of the body, a biopsy may be done to find out where the cancer began, which can help the doctor plan treatment.  If this is necessary a narrow, hollow needle is used to collect the tissue. This is called a fine-needle biopsy or fine-needle aspiration. The biopsy is performed by a radiologist who uses specialized imaging procedures, such as CT scans (see below), to guide the needle directly into the tumor. A pathologist then analyzes the sample(s) removed during the biopsy. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.

  • CT or CAT scan. A CT scan creates a 3-dimensional picture of the inside of the body using x-rays taken from different angles A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye is often injected into a patient’s vein through a peripheral intravenous (IV) line. This line is a short, plastic tube inserted into the vein that allows the health care team to give medication or fluids.

  • MRI. An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill to swallow.

  • Metaiodobenzylguanidine (MIBG) scan. MIBG is a chemical similar to adrenaline that will collect in a neuroendocrine tumor. A MIBG scan can show a tumor of the adrenal medulla that may not show up on an x-ray. The scan takes place over 2 consecutive days. On the first day, an injection of MIBG is given in the arm. Several hours later, pictures are taken with a special camera that can show if or where in the body the MIBG has collected. The following morning, more pictures are taken, and the process may be repeated if needed.

  • Adrenal Vein Sampling (AVS). In rare cases, a patient may have symptoms of a hormone-producing tumor, but CT or MRI scans may not identify a tumor or the patient may have small masses on both adrenal glands. In cases like this, an interventional radiologist can test the blood from the veins of each adrenal gland. The blood from each gland is tested to determine whether extra hormone is coming from the adrenal gland with the mass. This procedure is performed only by specialists and is done in a special radiology center. 

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is a tumor, these results also help the doctor describe it. This is called staging. 

The next section in this guide is Stages. It explains the system doctors use to describe the extent of the disease. Or, use the menu to choose another section to continue reading this guide.

Adrenal Gland Tumor - Stages

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2016

ON THIS PAGE: You will learn about how doctors describe a tumor’s growth or spread. This is called the stage. To see other pages, use the menu.

Staging is a way of describing where the tumor is located, if it is cancerous, if or where it has spread, and whether it is affecting other parts of the body.

Doctors use many diagnostic tests to find out the tumor’s stage. Staging may not be complete until all of the tests, or even the surgical removal of the tumor or adrenal gland, are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient’s prognosis, which is the chance of recovery. There are different stage descriptions for different types of tumors.

TNM staging system

One tool that doctors use to describe the stage of a tumor is the TNM system. Doctors use the results from diagnostic tests and scans to answer these questions:

  • Tumor (T): How large is the primary tumor? Where is it located?

  • Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?

  • Metastasis (M): Has the cancer metastasized to other parts of the body? If so, where and how much?

The results are combined to determine the stage of cancer for each person. This section covers the standard staging system for adrenocortical carcinoma, which includes 4 stages: stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

Here are more details on each part of the TNM system for adrenocortical carcinoma.

Tumor (T)

Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Some stages are also divided into smaller groups that help describe the tumor in even more detail. Specific tumor stage information is listed below.

TX: The primary tumor cannot be evaluated.

T0: There is no primary tumor.

T1: The tumor is 5 centimeters (cm) or less and has not grown outside the adrenal gland.

T2: The tumor is larger than 5 cm and has not grown outside the adrenal gland.

T3: The tumor can be any size. It has grown into the area around the adrenal gland but has not spread to nearby organs.

T4: The tumor is any size and has grown into any of the following:

  • Nearby tissues or organs, such as the kidney

  • The thin muscle under the lungs and heart that separates the chest from the abdomen, called the diaphragm

  • Larger blood vessels, such as the aorta and the vena cava

  • Pancreas

  • Spleen

  • Liver

Node (N)

The “N” in the TNM staging system stands for lymph nodes. These tiny, bean-shaped organs help fight infection.  Lymph nodes are found all over the body. Lymph nodes near where the tumor started are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes.

NX: The regional lymph nodes cannot be evaluated.

N0 (N plus zero): The cancer has not spread to the regional lymph nodes.

N1: The cancer has spread to the regional lymph nodes.

Metastasis (M)

The “M” in the TNM system indicates whether the cancer has spread to other parts of the body, called distant metastasis.

M0 (M plus zero): The cancer has not spread to other parts of the body.

M1: The cancer has spread to other parts of the body beyond the nearby organs.

Cancer stage grouping

Doctors assign the stage of the cancer by combining the T, N, and M information to say what stage the cancer is.

Stage I: The tumor is 5 cm or smaller and has not grown beyond the adrenal gland. It has not spread to the regional lymph nodes or to other parts of the body (T1, N0, M0).

Stage II: The tumor is larger than 5 cm. It has not grown beyond the adrenal gland or spread to regional lymph nodes or other parts of the body (T2, N0, M0).

Stage III: The tumor is described by the following:

  • It is 5 cm or smaller and has spread to the regional lymph nodes but not to other parts of the body (T1, N1, M0).

  • It is larger than 5 cm and has spread to the regional lymph nodes but not to other parts of the body (T2, N1, M0).

  • It is any size and has grown beyond the adrenal gland but not to nearby organs (T3, N0, M0).

Stage IV: The tumor is described by the following:

  • It is any size and has grown into the area around the adrenal gland but not to nearby organs. The tumor has spread to regional lymph nodes but not to other parts of the body (T3, N1, M0).

  • It is any size and has spread to nearby organs but not to the lymph nodes or other parts of the body beyond the nearby organs (T4, N0, M0).

  • It is any size and has spread to nearby organs. The tumor has spread to the regional lymph nodes but not to other parts of the body beyond the nearby organs (T4, N1, M0).

  • The tumor has spread to other parts of the body (any T, any N, M1).

Recurrent: Recurrent cancer is cancer that has come back after treatment. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition, published by Springer-Verlag New York, www.cancerstaging.net.

Information about the tumor’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. Or, use the menu to choose another section to continue reading this guide.

Adrenal Gland Tumor - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2016

ON THIS PAGE: You will learn about the different ways doctors use to treat people with this type of tumor. To see other pages, use the menu.

This section tells you the treatments that are the standard of care for this type of tumor. “Standard of care” means the best treatments known. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn if it is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Your doctor can help you consider all your treatment options. To learn more about clinical trials, see the About Clinical Trials and Latest Research sections.

Treatment overview

For an adrenal gland tumor, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams also include a variety of other health care professionals, including physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Up to 25% of adrenal tumors may be linked to a genetic syndrome (see the Risk Factors section). When planning treatment, it may be helpful to talk with a genetic counselor to learn whether the tumor is associated with a specific syndrome. If you are diagnosed with an adrenal tumor, it is important to learn if any other members of your family may have had any types of endocrine disease in the past. If so, the syndrome may affect other family members as well, and specific genetic tests may be recommended for them. Learn more about genetic testing.

Descriptions of the most common treatment options for an adrenal gland tumor are listed below. Treatment options and recommendations depend on several factors, including the type and stage of the tumor, possible side effects, and the patient’s preferences and overall health. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment. Learn more about making treatment decisions.

Surgery

Surgery is the removal of the tumor and, if necessary, some surrounding healthy tissue during an operation. Adrenalectomy is the surgical removal of the adrenal gland with the tumor. This may be needed to treat an adrenal gland tumor. A surgical endocrinologist is a surgeon who specializes in treating an endocrine tumor using surgery.

If the tumor is smaller than 5 cm and, based on its size or the way it looks on imaging scans, shows no evidence that it is cancerous, then laparoscopic surgery may be possible. Laparoscopic surgery is a minimally invasive technique in which the surgeon uses a lighted camera and special instruments and makes small incisions in the skin. This technique reduces pain and recovery time after surgery compared with traditional larger incisions. Laparoscopic surgery may be performed from the abdomen or back, depending on the location of the tumor and the experience of the surgeon.

If the tumor is possibly cancerous or larger than 5 cm, surgery using 1 larger incision in the abdomen or back is recommended. If the patient has previously had abdominal surgery, an incision in the back may be easier.

Surgery is also the main treatment option for a pheochromocytoma, the tumor of the adrenal medulla that produces excess catecholamines. Learn more about treatment options for a neuroendocrine tumor.

If laparoscopic surgery is performed, then the person can usually leave the hospital in 1 to 3 days and resume daily activities within a week. If a larger incision is needed, then the person is usually hospitalized for up to 5 to 7 days and should not lift heavy objects for 6 weeks after surgery.

Adrenal gland surgery can cause bleeding. The tumor can also make excess stress hormones, called catecholamines. If this is the case, the patient will need to be monitored and receive medication to treat high blood pressure during surgery. Patients with a tumor that produces very large amounts of hormones may require extensive medication and preparation before surgery. They may also need to stay in an intensive care unit for a short period after the surgery is performed. Talk with your surgeon before the operation about the possible side effects that you may experience and how they will be managed.

Learn more about the basics of cancer surgery.

Hormone therapy

Because adrenal gland tumors may produce excess hormones, the doctor may prescribe various medications to control the levels of these hormones before, during, or after other treatments. For example, if the tumor is a pheochromocytoma that is producing excess catecholamines, the patient may need a drug to lower the levels of these body chemicals before additional treatment can be given. Or, after surgery for an adrenocortical carcinoma that produces hormones, a patient may need medication to block the effects of excess cortisol. These drugs include metyrapone (Metopirone), metyrosine (Demser), spironolactone (Aldactone), and streptozocin (Zanosar).

Chemotherapy

Chemotherapy is the use of drugs to destroy tumor cells, usually by stopping the cells’ ability to grow and divide. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating a tumor with medication.

Systemic chemotherapy gets into the bloodstream to reach tumor cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or combinations of different drugs at the same time. Mitotane (Lysodren) is a medication used to treat cancer in the adrenal cortex. It reduces the amount of adrenocorticoids produced by the adrenal cortex.

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.

Learn more about the basics of chemotherapy and preparing for treatment. The medications used to treat adrenal gland tumors are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Radiation therapy

Radiation therapy is the use of high energy x-rays or other particles to destroy tumor cells. A doctor who specializes in giving radiation therapy to treat a tumor is called a radiation oncologist. Adrenal tumors require radiation therapy in very rare cases.

The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time.

Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished. Learn more about the basics of radiation therapy.

Getting care for symptoms and side effects

A tumor and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the tumor, an important part of care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of their tumor, may receive palliative care. It works best when palliative care is started as early as needed in the treatment process. People often receive treatment for the tumor and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional support, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the tumor, such as chemotherapy, surgery, or radiation therapy. Talk with your doctor about the goals of each treatment in the treatment plan.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and palliative care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it can be addressed as quickly as possible. Learn more about palliative care.   

Metastatic adrenal gland cancer

If an adrenal gland tumor has spread to another part in the body from where it started, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Also, clinical trials might be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

Your treatment may include a combination of surgery, radiation therapy, and chemotherapy. Palliative care will also be important to help relieve symptoms and side effects.

For many patients, a diagnosis of metastatic cancer can be very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

Remission and the chance of recurrence

A remission is when tumor cells cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED. 

A remission may be temporary or permanent. This uncertainty causes many people to worry that the tumor will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the tumor returning. Understanding the risk of recurrence and the treatment options may help you feel more prepared if it does return. Learn more about coping with the fear of recurrence.

If the tumor does return after the original treatment, it is called a recurrent tumor. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the treatments described above, such as surgery, chemotherapy, and radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent tumor. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

People with a recurrent adrenal gland tumor often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with recurrence.

If treatment fails

Recovery from an adrenal gland tumor is not always possible. If the tumor cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and advanced cancer is difficult to discuss for many people. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Patients who have an advanced tumor and who are expected to live less than 6 months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help cope with the loss. Learn more about grief and loss.

The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people who have been diagnosed with a tumor. Or, use the menu to choose another section to continue reading this guide.  

Adrenal Gland Tumor - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2016

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. To see other pages, use the menu.

What are clinical trials?

Doctors and scientists are always looking for better ways to care for patients with an adrenal gland tumor. To make scientific advances, doctors create research studies involving people, called clinical trials. In fact, every drug that is now approved by the U.S. Food and Drug Administration (FDA) was tested in clinical trials.

Many clinical trials focus on new treatments. Researchers want to learn if a new treatment is safe, effective, and possibly better than the treatment doctors use now. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials can be some of the first to get a treatment before it is available to the public. However, there is no guarantee that the new treatment will be safe, effective, or better than what doctors use now.

Some clinical trials study new ways to relieve symptoms and side effects during treatment. Others study ways to manage the late effects that may happen a long time after treatment. Talk with your doctor about clinical trials for symptoms and side effects. There are also clinical trials studying ways to prevent cancer.

Deciding to join a clinical trial

People decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that these studies are the only way to make progress in treating adrenal gland tumors. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with an adrenal gland tumor.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” However, placebos are usually combined with standard treatment in most cancer clinical trials. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient’s options, so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different from the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends.

Finding a clinical trial

Research through clinical trials is ongoing for all types of cancer. For specific topics being studied for adrenal gland tumors, learn more in the Latest Research section.

Cancer.Net offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of tumor.

In addition, this website offers free access to a video-based educational program about cancer clinical trials, located outside of this guide.

The next section in this guide is Latest Research. It explains areas of scientific research currently going on for this type of tumor. Or, use the menu to choose another section to continue reading this guide.

Adrenal Gland Tumor - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2016

ON THIS PAGE: You will read about the scientific research being done now to learn more about this type of tumor and how to treat it. To see other pages, use the menu.

Doctors are working to learn more about adrenal gland tumors, ways to prevent them, how to best treat them, and how to provide the best care to people diagnosed with them. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you.

  • Immunotherapy. Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight a tumor. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. The effectiveness of immunotherapy as a treatment for an adrenal gland tumor is being researched in clinical trials. Learn more about the basics of immunotherapy.

  • Molecular markers. Studies analyzing the role of genes and proteins in a person’s tumor are underway. The focus of these studies is to help fine-tune the diagnosis of adrenal gland tumors and predict treatment results.

  • Succinate dehydrogenase (SDH) tumors. SDH is a specialized protein that plays an important role in the body’s metabolism. Researchers think that when this gene is inactivated, it results in cancer, including adrenal gland tumors.

  • Palliative care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current adrenal gland tumor treatments to improve patients’ comfort and quality of life.

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research regarding adrenal gland tumors, explore these related items that take you outside of this guide:

The next section in this guide is Coping with Treatment. It offers some guidance in how to cope with the physical, emotional, and social changes that a tumor and its treatment can bring. Or, use the menu to choose another section to continue reading this guide.

Adrenal Gland Tumor - Coping with Treatment

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2016

ON THIS PAGE: You will find out more about steps to take to help cope with physical, social, and emotional side effects. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu.

Every treatment can cause side effects or changes to your body and how you feel. For many reasons, people don’t experience the same side effects even when given the same treatment for the same type of tumor. This can make it hard to predict how you will feel during treatment.

As you prepare to start treatment, it is normal to fear treatment-related side effects. It may help to know that your health care team will work to prevent and relieve side effects. Doctors call this part of cancer treatment “palliative care.” It is an important part of your treatment plan, regardless of your age or the stage of disease.

Coping with physical side effects

Common physical side effects from each treatment option for an adrenal gland tumor are described in the Treatment Options section. Learn more about side effects of cancer and its treatment, along with ways to prevent or control them. Changes to your physical health depend on several factors, including the tumor’s stage, the length and dose of treatment, and your general health.

Sometimes, physical side effects can last after treatment ends. Doctors call these long-term side effects. They call side effects that occur months or years after treatment late effects. Treating long-term side effects and late effects is an important part of survivorship care. Learn more by reading the Follow-up Care section of this guide or talking with your doctor.

Coping with emotional and social effects

You can have emotional and social effects as well as physical effects after a diagnosis. This may include dealing with difficult emotions, such as anxiety or anger, or managing your stress level. Sometimes, patients have problems expressing how they feel to their loved ones, or people don’t know what to say in return.

Patients and their families are encouraged to share their feelings with a member of their health care team. You can also find coping strategies for emotional and social effects in a separate section of this website. This section includes many resources for finding support and information to meet your needs.

Coping with financial effects

Medical treatment can be expensive. It is often a big source of stress and anxiety for people with an adrenal gland tumor and their families. In addition to treatment costs, many people find they have extra, unplanned expenses related to their care. For some people, the high cost stops them from following or completing their treatment plan. This can put their health at risk and may lead to higher costs in the future. Learn more about managing financial considerations, in a separate part of this website.

Caring for a loved one with cancer

Family members and friends often play an important role in taking care of a person with an adrenal gland tumor. This is called being a caregiver. Caregivers can provide physical, practical, and emotional support to the patient, even if they live far away.

Caregivers may have a range of responsibilities on a daily or as-needed basis. Below are some of the responsibilities caregivers take care of:

  • Providing support and encouragement

  • Giving medications

  • Helping manage symptoms and side effects

  • Coordinating medical appointments

  • Providing a ride to appointments

  • Assisting with meals

  • Helping with household chores

  • Handling insurance and billing issues

Learn more about caregiving.

Talking with your health care team about side effects

Before starting treatment, talk with your doctor about possible side effects. Ask:

  • Which side effects are most likely?

  • When are they are likely to happen?

  • What can we do to prevent or relieve them?

Be sure to tell your health care team about any side effects that happen during treatment and afterward, too. Tell them even if you don’t think the side effects are serious. This discussion should include physical, emotional, and social effects of cancer.

Also, ask how much care you may need at home and with daily tasks during and after treatment. This can help you make a caregiving plan.

The next section in this guide is Follow-up Care. It explains the importance of checkups after treatment has finished. Or, use the menu to choose another section to continue reading this guide. 

Adrenal Gland Tumor - Follow-Up Care

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2016

ON THIS PAGE: You will read about your medical care after treatment for an adrenal gland tumor is complete, and why this follow-up care is important. To see other pages, use the menu.

Care for people diagnosed with a tumor doesn’t end when active treatment has finished. Your health care team will continue to check to make sure the tumor has not returned, manage any side effects, and monitor your overall health. This is called follow-up care. 

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead. Learn more about the importance of follow-up care.

The endocrine system is a complex collection of hormone-producing glands that control many essential functions. If the adrenal gland that did not have the tumor is still working correctly after surgery, it should be able to provide enough of the hormones the body needs. Sometimes, a person needs hormone replacement therapy, such as steroids, because the body can’t produce enough hormones. Over time, the person can often lower the dosage and even stop taking the hormone replacement drug. An endocrinologist, a doctor who specializes in the endocrine system, should carefully monitor this process.

If both adrenal glands have been removed, long-term medication will be required to replace the hormones that are normally produced by these glands. You should also wear a medical-alert bracelet. If you ever become sick or fall unconscious, the bracelet can inform health care professionals of your condition.

Watching for recurrence 

One goal of follow-up care is to check for a recurrence. A tumor recurs because small areas of tumor cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms.

During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will also ask specific questions about your health. Some people may have blood tests or imaging tests as part of regular follow-up care, but testing recommendations depend on several factors including the type and stage of the tumor originally diagnosed and the types of treatment given.

For some people who’ve had an adrenal gland tumor, the risk of developing a tumor in the other gland is 10% or higher. Because of this, people treated for an adrenal gland tumor may need regular checkups with an endocrinologist to monitor recovery and detect any new tumor growth. In particular, adrenalcortical carcinoma can grow and spread quickly. Because it is rare, a person may want to participate in a clinical trial at a medical center with experience treating and monitoring this type of tumor. Talk with your doctor about locating these studies.

Managing long-term and late side effects

Most people expect to experience side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. In addition, other side effects called late effects may develop months or even years afterwards. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on the type of tumor, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may also have certain physical examinations, scans, or blood tests to help find and manage them. 

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to ask about any concerns you have about your future physical or emotional health. ASCO offers forms to help create a treatment summary to keep track of the treatment you received and develop a survivorship care plan once treatment is completed.

This is also a good time to decide who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the general care of their family doctor or another health care professional. This decision depends on several factors, including the type and stage of the tumor, side effects, health insurance rules, and your personal preferences. 

If a doctor who was not directly involved in treating the adrenal gland tumor will lead your follow-up care, be sure to share your treatment summary and survivorship care plan forms with him or her, as well as all future health care providers. Details about your treatment for an adrenal gland tumor are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after being diagnosed with a cancerous tumor. Or, use the menu to choose another section to continue reading this guide.

Adrenal Gland Tumor - Survivorship

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2016

ON THIS PAGE: You will read about how to with challenges in everyday life after being diagnosed with a cancerous tumor. To see other pages, use the menu.

What is survivorship?

The word “survivorship” means different things to different people. Common definitions include:

  • Having no signs of cancer after finishing treatment.

  • Living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and includes people who continue to have treatment over the long term, to either reduce the risk of recurrence or to manage chronic disease.

Survivorship is one of the most complicated parts of having cancer. This is because it is different for everyone.

Survivors may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain of how to cope with everyday life.

Survivors may feel some stress when frequent visits to the health care team end following treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true as new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexuality and fertility concerns, and financial and workplace issues.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

  • Understanding the challenge you are facing,

  • Thinking through solutions,

  • Asking for and allowing the support of others, and

  • Feeling comfortable with the course of action you choose.

Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the center where you received treatment.

Changing role of caregivers

Family members and friends may also go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the cancer diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving in this article.

A new perspective on your health

For many people, survivorship serves as a strong motivator to make positive lifestyle changes.

People recovering from an adrenal gland tumor are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, and managing stress. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

In addition, it is important to have recommended medical check-ups and tests (see Follow-up Care) to take care of your health. Cancer rehabilitation may also be recommended, and this could mean any of a wide range of services such as physical therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent and productive as possible.

Talk with your doctor to develop a survivorship care plan that is best for your needs.

Looking for More Survivorship Resources?

For more information about cancer survivorship, explore these related items. Please note these links will take you to other sections of Cancer.Net:

  • ASCO Answers Cancer Survivorship Guide: Get this 44-page booklet that helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms. The booklet is available as a PDF, so it is easy to print out.

  • Cancer.Net Patient Education Video: View a short video led by an ASCO expert that provides information about what comes next after finishing treatment.

  • Survivorship Resources: Cancer.Net offers an entire area of this website with resources to help survivors, including for survivors in different age groups.

The next section offers Questions to Ask the Doctor to help start conversations with your health care team. Or, use the menu to choose another section to continue reading this guide.

Adrenal Gland Tumor - Questions to Ask the Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2016

ON THIS PAGE: You will find some questions to ask your doctor or other members of your health care team, to help you better understand your diagnosis, treatment plan, and overall care. To see other pages, use the menu.

Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your medical care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your care.

Questions to ask after getting a diagnosis

  • What type of adrenal gland tumor do I have?

  • Is the tumor cancerous?

  • Is the tumor functional or nonfunctional? What does this mean?

  • Is the tumor located only in the adrenal gland?

  • Can you explain my pathology report (laboratory test results) to me?

  • Should I talk with a genetic counselor before I start treatment?

  • Could my family members be at risk for developing an adrenal gland tumor? Should they talk with a genetic counselor?

Questions to ask about choosing a treatment and managing side effects

  • What are my treatment options?

  • What clinical trials are available for me? Where are they located, and how do I find out more about them?

  • What treatment plan do you recommend? Why?

  • Will I need hormone therapy? For how long?

  • What is the goal of each treatment? Is it to eliminate the tumor, help me feel better, or both?

  • Who will be part of my health care team, and what does each member do?

  • Who will be leading my overall treatment?

  • What is my prognosis?

  • How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

  • Could this treatment affect my sex life? If so, how and for how long?

  • Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?

  • If I’m worried about managing the costs of medical care, who can help me?

  • What support services are available to me? To my family?

  • Whom should I call for questions or problems?

  • Is there anything else I should be asking?

Questions to ask about having surgery

  • Is surgery required? If so, what type of surgery? Will the entire adrenal gland be removed?

  • How experienced is the surgeon with this type of surgery?

  • How long will the operation take?

  • How long will I be in the hospital?

  • Can you describe what my recovery from surgery will be like?

  • What are the possible long-term effects of having this surgery?

Questions to ask about having radiation therapy

  • Is radiation therapy an option to treat the tumor?

  • What type of radiation therapy do you recommend?

  • What is the goal of radiation therapy?

  • How many treatments will I need, and how long will each one take?

  • What side effects can I expect during treatment?

  • What are the possible long-term effects of having radiation therapy?

  • What can be done to prevent or manage these side effects?

Questions to ask about having chemotherapy

  • What type of chemotherapy do you recommended?

  • What is the goal of this treatment? Can chemotherapy control the tumor?

  • How will the treatment be given? Through an IV or orally?

  • How often will I receive chemotherapy? For how long?

  • Will I receive chemotherapy at a hospital or clinic? Or will I take it at home?

  • What side effects can I expect during treatment?

  • What are the possible long-term effects of this chemotherapy regimen?

  • What can be done to prevent or manage these side effects?

Questions to ask about planning follow-up care

  • What is the chance that the tumor will come back? Should I watch for specific signs or symptoms?

  • What long-term side effects or late effects are possible based on the treatment(s) I received?

  • What follow-up tests will I need, and how often will I need them?

  • How do I get a treatment summary and survivorship care plan to keep in my personal records?

  • Who will be leading my follow-up care?

  • What survivorship support services are available to me? To my family?

  • Will I need to have hormone replacement therapy? For how long?

The next section in this guide is Additional Resources. It offers some more resources on this website beyond this guide that may be helpful to you. Or, use the menu to choose another section to continue reading this guide.

Adrenal Gland Tumor - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2016

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Adrenal Gland Tumor. To go back and review other pages, use the menu.

Cancer.Net includes many other sections about the medical and emotional aspects of a tumor, both for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond.

Beyond this guide, here are a few links to help you explore other parts of Cancer.Net:

This is the end of Cancer.Net’s Guide to Adrenal Gland Tumor. Use the menu to select another section to continue reading this guide.