ON THIS PAGE: You will learn about the different types of treatments doctors use for people with an adrenal gland tumor. Use the menu to see other pages.

This section explains the types of treatments that are the standard of care for adrenal gland tumors. “Standard of care” means the best treatments known. When making treatment plan decisions, you 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. Clinical trials are an option to consider for treatment and care for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

How an adrenal gland tumor is treated

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. Your health care team may also include a variety of other health care professionals, including physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Up to 30% of adrenal tumors that produce catecholamines (pheochromocytomas) 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 gland 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 members of your family, and specific genetic tests may be recommended for them. Learn more about genetic testing.

The common types of treatments used for an adrenal gland tumor are described below. Your care plan also includes treatment for symptoms and side effects, an important part of care.

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. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving treatment. These types of talks are called “shared decision-making.” Shared decision-making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision-making is particularly important for adrenal gland tumors because there are different treatment options. Learn more about making treatment decisions.

Surgery

Surgery is the removal of the tumor and, if necessary, some surrounding healthy tissue during an operation. A surgical endocrinologist is a surgeon who specializes in treating an endocrine tumor using surgery.

An adrenalectomy is the surgical removal of the adrenal gland with the tumor. This may be needed to treat an adrenal gland tumor.

If the tumor is small 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. The size of the tumor that can be removed using laparoscopic surgery depends on the surgeon.

If the tumor is possibly cancerous or is larger in size, then surgery using a larger incision in the abdomen is recommended instead of laparoscopic surgery.

If laparoscopic surgery is performed, then the person can usually leave the hospital in 1 to 3 days and can often restart their regular daily activities within a week. If a larger incision is needed, then the person is usually hospitalized for up to 4 to 7 days and should not lift heavy objects for 6 weeks after surgery.

People who have an adrenal tumor producing certain hormones need special preparation for surgery. For instance, patients with pheochromocytoma, where there is excessive production of blood pressure hormones called catecholamines, need to take 3 to 4 weeks of medication called alpha blockade before their surgery. Alpha blockade decreases the effects of these hormones on blood pressure. As a result, the surgery will be safer, with less blood pressure fluctuations during the operation.

Occasionally, people need to stay in the intensive care unit (ICU) as part of their recovery from adrenal surgery.

Before surgery, talk with your surgeon about the possible side effects from the specific surgery you will have, what preparations may be needed before surgery, and what your recovery may be like afterward. Learn more about the basics of cancer surgery.

Therapies using medication

Treatments using medication are used to destroy tumor cells. Medication may be given through the bloodstream to reach tumor cells throughout the body. When a drug is given this way, it is called systemic therapy. Medication may also be given locally, which is when the medication is applied directly to the tumor or kept in a single part of the body.

This type of medication is generally prescribed by a medical oncologist, a doctor who specializes in treating tumors with medication.

Medications are often given through an intravenous (IV) tube placed into a vein using a needle or as a pill or capsule that is swallowed (orally). If you are given oral medications, be sure to ask your health care team about how to safely store and handle it.

The types of medications used for adrenal gland tumors include:

• Hormone therapy

• Chemotherapy

Each of these types of therapies is discussed below in more detail. A person may receive 1 type of medication at a time or a combination of medications given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy.

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.

It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with medications to treat your tumor, causing unwanted side effects or reduced effectiveness. Learn more about your prescriptions by using searchable drug databases.

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, after surgery for an adrenocortical carcinoma that produces hormones, a patient may need medication to block the effects of excess cortisol. Some of these drugs include metyrapone (Metopirone), metyrosine (Demser), spironolactone (Aldactone), and streptozotocin (Zanosar).

Chemotherapy

Chemotherapy is the use of drugs to destroy tumor cells, usually by keeping the cancer cells from growing, dividing, and making more cells.

A chemotherapy regimen, or 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 a combination of different drugs given 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.

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. In very rare cases, adrenal gland tumors require radiation therapy.

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, or 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.

Physical, emotional, and social effects

A tumor and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the tumor.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of the tumor, may receive this type of care. And it often works best when it is started right after the diagnosis. People who receive palliative care along with treatment for the tumor often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the adrenal gland tumor, such as chemotherapy, surgery, or radiation therapy.

Before treatment begins, talk with your doctor about the goals of each treatment in the treatment plan being recommended. You should also talk about the possible side effects of the specific treatment plan and palliative care options. Many patients also benefit from talking with a social worker and participating in support groups. Ask your doctor about these resources, too.

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

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. Clinical trials might also 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 people, a diagnosis of metastatic cancer is very stressful and difficult. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, such as through a support group or other peer support program.

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 returns 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 new 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 the 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 sometimes experience emotions such as disbelief or fear. You are encouraged to talk with their health care team about these feelings and ask about support services to help you cope. Learn more about dealing with recurrence.

If treatment does not work

Recovery from an advanced 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 for some people, it is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

People who have an advanced tumor and who are expected to live less than 6 months may want to consider 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 talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. 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 an adrenal gland tumor. Use the menu to choose a different section to read in this guide.