Most tumors of the adrenal glands are benign (not cancer). Adrenal cancer is very rare. At Seattle Cancer Care Alliance (SCCA), our endocrine tumor specialists — all UW Medicine doctors — have experience evaluating and treating people with this uncommon disease.
What is adrenal cancer?
You have 2 adrenal glands — 1 on top of each of your 2 kidneys. These organs are in the back of your abdomen, just under your rib cage.
The adrenal glands are part of your endocrine system, which means they make and release hormones. Hormones control many functions around your body.
The outer part of your adrenal gland is called the adrenal cortex. It makes hormones that change your metabolism (how your body uses food for energy). Hormones from your adrenal cortex also control your blood pressure and features, like hair growth and body shape, linked with male and female hormones. Two of the main hormones from the adrenal cortex are aldosterone and cortisol.
The inner part of your adrenal gland is called the adrenal medulla. It makes hormones that control how your body responds to stress. These are most commonly known as adrenaline.
Adrenal cancer happens when adrenal cells mutate and don’t respond to normal signals that govern how cells multiply or when they die. Cancer cells can grow to form tumors and can spread beyond the adrenal gland to other parts of the body.
Types of adrenal cancer
There are two main types of adrenal cancer in adults:
- Adrenocortical carcinoma — This type starts in the outer part of the adrenal gland (cortex). It is also called adrenal cortical carcinoma.
- Pheochromocytoma — This type starts in the adrenal medulla. It’s a type of neuroendocrine tumor (NET). NETs start in special cells that are part of the endocrine system but that also have traits of nerve cells. Pheochromocytoma tumors can be benign; only a small fraction are cancer.
Tumors that make excess hormones are called functioning tumors. Tumors that don’t are called nonfunctioning. Adrenal cancers can be either functioning or nonfunctioning.
Symptoms of adrenal cancer
Many of the symptoms of adrenal cancer depend on whether the tumor makes excess hormones, and if so, which ones. Tumors that make too much of a hormone can cause a wide range of signs and symptoms, including:
- Weight gain in the face, neck and trunk (but not the arms and legs)
- High blood pressure
- Heart palpitations
- Muscle weakness
- Excess sweating
- Excess hair growth
- Changes in sex drive or swelling of breasts or genitals
- Changes in menstrual periods
Symptoms can also happen if an adrenal tumor becomes large enough to press on other tissues or organs in your abdomen. For instance, a large tumor might make you feel unusually full or cause pain.
Some people with adrenal cancer don’t have any symptoms. Their doctor may suspect cancer only because a tumor showed up on imaging studies, like a computed tomography (CT) scan, done for some other reason.
Diagnosing adrenal cancer
If your doctor suspects you might have adrenal cancer, the doctor will examine you, ask about your medical history and ask for tests, such as:
- Blood and urine tests — to check whether your adrenal gland is making excess hormones. This can be important even if you don’t have symptoms, because sometimes the effects of hormones are subtle.
- Imaging studies — to take pictures of the inside of your body. These studies may include a CT scan, magnetic resonance imaging (MRI) or other scans.
For some forms of cancer, doctors do a biopsy by taking a sample of cells from the tumor using a hollow needle. For adrenal cancer, doctors typically don’t do this. Instead, if you have a mass that appears to be adrenal cancer, doctors generally recommend having surgery to take out the mass. After it’s removed, the mass is checked for cancer.
Stages of adrenal cancer
If have adrenal cancer, you will need further tests to learn the extent of the cancer and to find out if the cancer cells have spread (metastasized) to other parts of your body.
This process is called staging. It is important to know the stage of your disease in order to decide on the best treatment for you.
Adrenal cancers are assigned a stage from I to IV, with I being the least advanced and IV being the most advanced.
Adrenal cancer tends to be aggressive and grow quickly. Your adrenal cancer care team will talk with you about the stage of your cancer, how quickly it’s likely to grow, what this means for your treatment and what to expect.
Risk factors for adrenal cancer
Most of the time, there’s no clear cause for adrenal cancer. The following inherited disorders may increase your risk:
- Beckwith-Wiedemann syndrome
- Carney complex
- Li-Fraumeni syndrome
- Multiple endocrine neoplasia type 2
- Lynch syndrome (hereditary nonpolyposis colorectal cancer)
- Neurofibromatosis type 1
- Von Hippel-Lindau syndrome
If you have one of these conditions, talk with your doctor about having an exam and evaluation each year. Likewise, if you have adrenal cancer, talk with your doctor about whether to have genetic testing for the conditions that increase risk. These conditions may put you (and your relatives) at risk for other health problems, including other cancers, too.