Adrenal Gland Cancer

21.03.2024

DIAGNOSIS AND TREATMENT OF ADRENAL GLAND TUMORS

Adrenal tumor refers to abnormal cell growth or mass formed in the adrenal glands (adrenal glands). These types of tumors may arise in the cortex (outer layer) or medulla (inner layer) parts of the adrenal glands and are sometimes associated with hormone production. Adrenal tumors can be benign or malignant. These can cause overproduction of hormones such as cortisol, aldosterone and adrenaline, which are hormones that regulate the body's metabolism and stress response. Early diagnosis and treatment of adrenal tumors is important because they can cause hormone excess, which can lead to health problems such as hypertension, obesity, and diabetes. Additionally, malignant adrenal tumors can cause the spread of cancer cells. Therefore, diagnosis and treatment of adrenal tumors are important to protect the patient's health.

WHAT ARE THE RISK FACTORS?

Although the exact causes of adrenal tumors are not fully known, some risk factors have been identified.

Gender: Some types of adrenal tumors are more common in women or men. For example, aldosterone-producing tumors are more common in women, while pheochromocytoma can occur equally frequently in men and women.

Age: Adrenal tumors are generally more common in middle age and later.

Genetic Factors: Family history may increase the risk of adrenal tumors. Genetic diseases, especially multiple endocrine neoplasia (MEN) syndromes, may increase the risk of adrenal tumors.

Here are some of these syndromes:

MEN type 1: May increase the risk of parathyroid, pancreatic and pituitary tumors.

MEN type 2: May increase the risk of medullary thyroid cancer and pheochromocytoma.

Exposure to Radiation: The risk of adrenal tumors may be increased in people who received radiation therapy to the head or neck area during childhood.

Hormonal Factors: Some hormonal changes can affect the development of adrenal tumors. For example, hormones that cause an excess of cortisol or aldosterone may increase the risk of adrenal tumors.

Risk factors for adrenal tumors may vary from person to person and may not be an underlying risk factor for all adrenal tumors. However, considering risk factors is important to support early diagnosis and treatment of the disease. Therefore, people at risk of adrenal tumors are recommended to have regular health checks and follow doctor's recommendations.

Image 1: In the presence of adrenal cancer, different complaints such as muscle weakness, weight gain, fever and vomiting may be observed.

WHAT ARE THE SYMPTOMS?

Signs and symptoms of adrenal tumors may vary depending on the tumor type, size, and hormone production.

Possible symptoms of adrenal tumors:

Hypertension (High Blood Pressure): Adrenal tumors that produce aldosterone can cause high blood pressure.

Muscle Weakness and Muscle Cramps: Cortisol-producing tumors that cause cortisol excess can lead to muscle weakness, fatigue, and muscle cramps.

Obesity: Excess cortisol can lead to fat accumulation in the body and lead to obesity.

Diabetes: Increased cortisol levels can increase insulin resistance and increase the risk of type 2 diabetes.

Urinary Urinary Urinary Urinary and Thirst: Water retention, which occurs as a result of excessive production of antidiuretic hormone, can cause frequent urination and a feeling of thirst.

Sexual Problems: Adrenal tumors that affect sexual hormones can cause loss of libido, menstrual irregularities, or sexual dysfunction.

Stomach ache: An enlarged adrenal tumor can cause abdominal pain.

Weight Loss: Some adrenal tumors can increase energy expenditure in the body, leading to weight loss.

Symptoms and signs of adrenal tumors can vary depending on how the tumor affects hormone production. Therefore, in case of suspicion of an adrenal tumor, it is important to be evaluated by a healthcare professional and have the necessary tests performed for diagnosis.

HOW IS IT DIAGNOSED?

The diagnosis of adrenal tumors is made by a series of clinical and radiological tests. In the first stage, the patient's symptoms and physical examination are evaluated. Hormone levels are then examined with blood tests. Adrenal tumors sometimes produce hormones, and excess of these hormones can be detected by blood tests. Radiological imaging tests are used to evaluate the size, location, and spread of the adrenal tumor. These tests may include computed tomography (CT) scans, magnetic resonance imaging (MRI), and positron emission tomography (PET). Once the diagnosis is finalized, an attempt is made to determine whether the adrenal tumor is benign or malignant. This is usually done by methods such as tissue biopsy or fine needle aspiration (FNA). The diagnostic process is conducted collaboratively between specialists such as an endocrinologist, radiologist, and pathologist and is customized to the patient's unique situation.

WHAT ARE THE PATHOLOGICAL TYPES?

Adrenal tumors can be divided pathologically into different types, and these types define the characteristics and structure of the tumor.

Common pathological types of adrenal tumors:

Adenoma: Adenomas are benign tumors that arise from the adrenal cortex and often do not produce hormones. They are usually discovered incidentally during radiological imaging.

Cortical Carcinoma: These are malignant tumors originating from the adrenal cortex. Cortical carcinomas are rare, but they can grow aggressively and produce hormones.

Feokromositoma: Pheochromocytomas are tumors that arise from the adrenal medulla and often cause excessive production of hormones such as adrenaline and norepinephrine. These tumors can lead to hypertension and other hormonal problems.

Neuroblastoma: These tumors originate from the medulla region of the adrenal glands and are mostly seen in children. Neuroblastomas are usually malignant.

Ganglioneuroma: Ganglioneuromas are benign tumors arising from the adrenal medulla or nervous tissue. They usually do not cause hormonal activity and rarely become cancerous.

The pathological type of each adrenal tumor provides information about the structure, growth and behavior of the tumor. Pathologists determine the pathological type of the tumor using tissue biopsies and examinations under the microscope. This information is important in determining the treatment plan and the patient's prognosis. Additionally, in both types of adrenal tumors, various molecular and genetic markers can be examined to determine whether the tumor is malignant. These tests are important for treatment planning because malignant tumors often require more aggressive treatment.

Image 2: Adrenal cancers can develop from different layers of the adrenal gland and hormone production may occur.

HOW IS STAGING DONE?

Staging of adrenal tumors helps determine the severity of the cancer by evaluating the tumor's size, spread, and other factors. Staging of adrenal tumors is usually based on the following factors:

Tumor Size: Tumor size is an important factor in tumor staging. Larger tumors are usually classified in more advanced stages.

Spread to Lymph Nodes: It is examined whether the tumor has spread to the surrounding lymph nodes. Spread to lymph nodes helps determine the stage of the cancer.

Distant Metastasis: It is evaluated whether the tumor has metastasized to other parts of the body. Distant metastasis affects the stage of the cancer and treatment options.

Hormone Production: Whether the tumor produces hormones and which hormones it produces is also important in staging. Tumors that cause hormone excess usually undergo different staging.

Staging of adrenal tumors may vary depending on the type of tumor and the specific condition of the patient. However, tumors are generally classified as stage 1 (earliest stage) to stage 4 (most advanced stage). This staging evaluates the extent and severity of the disease and helps determine the appropriate treatment plan. Staging is based on factors such as radiological imaging tests, biopsy results, and the patient's general health condition.

HOW IS TREATMENT DONE ACCORDING TO STAGES?

Treatment of adrenal tumors may vary depending on the stage and type of the tumor. Treatment approaches according to different stages of adrenal tumors:

Stage 1 Adrenal Tumors: At this stage, the tumor is limited only to the adrenal gland and has not spread. Generally, surgical intervention is sufficient at this stage. The tumor and surrounding intact tissue are removed and it is determined whether the tumor is benign or malignant.

Stage 2 Adrenal Tumors: The tumor spread from the adrenal gland to surrounding tissues, but did not metastasize to distant organs. Surgery is often a treatment option at this stage as well, but the operation may be more complex. Radiotherapy or hormone therapy may also be required after surgery.

Stage 3 Adrenal Tumors: The tumor has spread to large vessels or surrounding tissues or lymph nodes, but has not metastasized to distant organs. Treatment may include surgery, radiotherapy or other local treatments. Hormone therapy can also be used to regulate hormonal balance.

Stage 4 Adrenal Tumors: At this stage, the tumor has metastasized to distant organs. Treatment may include surgical removal of distant metastases, radiotherapy, chemotherapy, or targeted therapies. Treatment options and approach may vary depending on the organs that metastasize.

The treatment plan is determined according to the patient's general health condition, tumor type and stage. A personalized treatment plan is created for each patient and guided by a multidisciplinary healthcare team. Although surgery is usually the primary option in the treatment of adrenal tumors, the stage and characteristics of the tumor may require other treatment modalities.

Image 3: The main method in the treatment of adrenal cancer is surgery. In advanced cases, chemotherapy and radiotherapy may be applied.

WHAT ARE THE SYSTEMIC DRUGS USED IN TREATMENT?

Methods used in the treatment of adrenal tumors may include options such as chemotherapy, hormonal drugs, smart drug treatments and immunotherapy. Information about some of these treatment methods is given item by item.

Chemotherapy:

Mitotane: It is a chemotherapeutic drug used in the treatment of adrenal tumors. It may help slow tumor growth.

Corticosteroids: In adrenal tumors that cause cortisol excess, corticosteroids can be used to regulate cortisol levels and control symptoms.

Smart Drug Therapies:Sunitinib: It is a targeted therapy drug used in the treatment of adrenal tumors. Examp.: sunitinib, entrectinib,

Immunotherapy:

Immune Checkpoint Inhibitors: Pembrolizumab, nivolumab. The role of immunotherapy in the treatment of adrenal tumors is still being investigated. Drugs that target programmed cell death proteins (PD-1 or PD-L1) can help the immune system recognize and attack cancer cells.

These medications and treatment methods may vary depending on the type and stage of the adrenal tumor and the specific condition of the patient. The treatment plan is determined by a multidisciplinary healthcare team based on the patient's specific condition, and the patient's response is monitored regularly.

HOW SHOULD FOLLOW-UP BE CARRIED OUT AFTER RECOVERY?

Follow-up after treatment of adrenal tumors is of great importance to monitor the patient's health and detect recurrence or complications early. Post-recovery follow-up may include the following components:

Hormonal Monitoring: Regular monitoring of hormonal balance helps to identify hormonal changes caused by the tumor and, if necessary, adjust hormone therapy.

Imaging Tests: Radiological imaging tests (for example, computed tomography or magnetic resonance imaging) may be used to monitor tumor recurrence or the formation of new tumors.

Blood Tests: Blood tests are used to evaluate the patient's general health status and laboratory results. Calcium levels and other biochemical parameters are checked regularly.

Routine Follow-up Examinations: It is important for patients to attend regular doctor visits and share their symptoms. During these examinations, the doctor can make early diagnosis of any problems.

Psychological support: Psychological needs of patients should also be taken into consideration after adrenal tumor treatment. Resources such as support groups or psychotherapy can help support patients' emotional and psychological well-being.

Follow-up after adrenal tumor treatment plays a critical role to closely monitor the patient's health status and adjust treatment when necessary, thus helping patients achieve the best results. Therefore, regular follow-up is important for patients.