Treatment Choices by Stage of Adrenal Cancer

Treatment of adrenal cancer depends to a large degree on where the cancer started and how far it has spread.

Stages I and II

Surgery is the main treatment for stage I and stage II adrenal cancers. The entire adrenal gland will be removed. Since a person has 2 adrenal glands, removal of the diseased one does not generally cause problems. If nearby lymph nodes are enlarged, they will be removed as well and checked to see if they have cancer cells. These lymph nodes are not usually removed unless they are enlarged.

For many people, no further treatment is necessary. If the tumor had “high risk features,” treatment with radiation and/or mitotane may be given after surgery to help keep the cancer from coming back. High risk features of adrenal tumors include:

• The margins of the removed tumor have cancer cells.
• The tumor has a Ki-67 percentage (> 10%).  A high Ki-67 score means that tumor cells are dividing quickly.
• The tumor capsule ruptured before or during surgery.
• The tumor is large.

The tumor has a high grade, which means the cancer cells look very abnormal under the microscope and is likely to grow fast.

When treatment given after surgery has removed all visible cancer, it is called adjuvant therapy. The goal of adjuvant therapy is to kill any cancer cells that may have been left behind but are too small to be seen. Killing these cells may lower the chance the cancer will come back later.

Stage III

Surgery is the main treatment for stage III adrenal cancer. The goal of surgery is to remove all of the cancer. The adrenal gland with the tumor is always removed, and the surgeon might also need to remove tissue around the adrenal gland, including part (or all) of the nearby kidney and part of the liver. The lymph nodes near the adrenal gland will also be removed. After surgery, adjuvant therapy with radiation and/or mitotane may be given to help keep the cancer from coming back.

Stage IV or unresectable disease

When the cancer cannot be safely removed (unresectable) or has spread to other parts of the body (stage IV), the goal of treatment is to improve the patient’s symptoms and quality of life. Management options include:

• Observation: This may be an option for people with certain adrenal cancers that are growing relatively slowly and not causing any symptoms. Your doctor may talk about monitoring the cancer with scans with or without bloodwork.
• Surgery: Some doctors may still recommend surgery to remove as much of the tumor as possible. This type of surgery is called debulking. Removing most of the cancer may help reduce symptoms by lowering the production of hormones.
• Localized Therapy: This includes ablative therapy or radiation therapy, which may be used to treat any areas of cancer that are causing symptoms. For example, radiation can help when cancer that has spread to the bones is causing pain.
• Systemic Therapy:  This is therapy that can reach throughout the body, such as chemotherapy and immunotherapy. 

Recurrent adrenal cancer

Cancer is called recurrent when it comes back after treatment. Recurrence can be:

• Local (in or near the same place it started) 
• Distant (in other organs such as the lungs or bones)
• recurrence may be treated with surgery to remove the cancer or with radiation to destroy the cancer. Surgery is more likely to be done if all the cancer can be removed. Distant recurrence is treated like stage IV disease. For more information on recurrence, see Understanding Recurrence.

Most of the time, these treatments may provide only temporary help because the tumor will eventually continue to grow. When this happens and these treatments are no longer controlling the cancer, a focus on achieving a good quality of life may be the best choice. There are many other ways your doctor can help maintain your quality of life and control your symptoms. This means that it is important that you tell your doctor how you are feeling and what symptoms you are having. This type of treatment is called palliative care.

For more information, see Understanding Palliative Care.