Adrenal Cancer: Staging and Treatment

What is staging for cancer?

Staging helps you learn where your cancer is, how much is in your body, and if it has spread. Staging helps guide your treatment. For adrenal cancer, some tests will help stage your cancer:

• 24-hour urinary-free cortisol test: This will tell how much cortisol (a type of hormone) is in the urine.
• Dexamethasone suppression test: to lower cortisol levels in blood.
• CT, Ultrasound, or MRI.

The staging system used to describe adrenal cancer is the "TNM system,” as described by the American Joint Committee on Cancer (AJCC). The TNM systems are used to describe many types of cancers. They have three parts:

• T-describes the size/location/extent of the "primary" tumor in the adrenal gland.
• N-describes if the cancer has spread to the lymph nodes.
• M-describes if the cancer has spread to other organs (metastases).

The complex staging system for adrenal cancer uses the TNM system. Talk to your provider about your stage. The stages are shown here:

Stage I (T1, N0, M0): The tumor is 5 cm (centimeters) wide or smaller and is only in the adrenal gland (T1). There is no spread to other organs or lymph nodes (N0, M0).

Stage II (T2, N0, M0): The tumor is larger than 5 cm but is only in the adrenal gland (T2). There is no spread to lymph nodes (N0) or distant organs (M0).

Stage III:

• (T1, N1, M0): The tumor is 5 cm (centimeters) wide or smaller and is only in the adrenal gland, not in the tissue around it (T1). There are tumors in the lymph nodes (N1) but not in distant tissues or organs (M0).
• (T2, N1, M0): The tumor is larger than 5 cm and is only in the adrenal gland, not in the tissue around it (T2). There are tumors in the lymph nodes (N1) but not in distant tissues or organs (M0).
• (T3, any N, M0): The cancer is in the fat around the adrenal gland, and it is any size (T3). The tumors may or may not affect the lymph nodes (Any N0) and distant organs are not affected (M0).
• (T4, any N, M0): The tumor is affecting nearby organs and it is any size (T4). The cancer may or may not be in the lymph nodes (any N) and it is not in distant organs (M0).

Stage IV (any T, any N, M1): The tumors can be any size and may or may not affect tissue (any T) or lymph nodes (any N). The tumor has spread to distant organs (M1).

How is adrenal cancer treated?

Benign tumors do not spread (called adenomas) and are only treated if they are causing symptoms. Malignant tumors can spread and should be treated. There are many types of adrenal cancers, and your treatment may be based on the type you have. To learn more about the types, see our Adrenal Cancer: The Basics article.

Treatment for adrenal cancer is also based on your cancer stage, age, overall health, and test results. Your treatment options may be:

• Surgery.
• Chemotherapy.
• Radiation therapy.
• Other medication treatments.
• Clinical trials.

Surgery

Surgery to remove an adrenal tumor is called adrenalectomy. This surgery involves one or both adrenal glands being taken out. If the cancer has spread to other organs, they may need to be removed.

Your surgeon will try to debulk your tumor, meaning that they will try to take out as much as possible. Debulking a tumor can help improve symptoms. Your healthcare provider may suggest chemotherapy or radiation before or after surgery.

Chemotherapy

Chemotherapy is a group of medications that are given to treat cancer. These medications travel throughout the body to kill cancer cells. If cancer cells have broken off from the tumor and are somewhere else inside the body, chemotherapy has the chance of killing them.

The most common chemotherapy medications for adrenal cancer are mitotane,etoposide, doxorubicin,cisplatin, and streptozocin.

Radiation Therapy

Radiation therapy is the use of high-energy x-rays to kill cancer cells. It is not often used to treat adrenal cancers. Radiation may be used in cases where surgical removal of the cancer is incomplete or in cases where the cancer comes back after surgery. It may also be used as a palliative treatment. Palliative treatment manages symptoms like pain but does not cure the cancer.

Other Medication Treatments

Your healthcare provider may recommend medications to help with side effects due to hormone levels being too high or too low. Some medications you may take are ketoconazole, metyrapone, spironolactone, mifepristone, tamoxifen, toremifene, and fulvestrant.

Clinical Trials

You may be offered a clinical trial as part of your treatment plan. To find out more about current clinical trials, visit the OncoLink Clinical Trials Matching Service.

Making Treatment Decisions

Deciding on your treatment plan is your decision and your care team will help you. This can be overwhelming as you may be given a few options to choose from. It feels like an emergency, but you can take a few weeks to meet with different providers and think about your options and what is best for you. Friends and family can help you talk through the options and the pros and cons of each, but they cannot make the decision for you. You need to be comfortable with your decision – this will help you move on to the next steps. If you ever have any questions or concerns, be sure to call your team.

You can learn more about adrenal cancer at Oncolink.org.