Adrenal cancer is a rare cancer that begins in one or both small, triangular glands (adrenal glands) on top of the kidneys. The adrenal, an endocrine organ, performs two physiological functions:
- Outer adrenal cortex: Produces steroid hormones, including glucocorticoids such as cortisol, and mineralocorticoids (aldosterone and dehydroepiandrosterone)
- Inner adrenal medulla: Produces catecholamines [dopamine and adrenaline (epinephrine and norepinephrine)]
Adrenal cancer can occur at any age but is most likely to affect children younger than five and adults in their 40s and 50s. Adrenal masses or lesions can be categorized as functional (hormone-secreting) or silent (benign or malignant). Overall, less than 1% of these tumors are cancerous.
The cost-effective medical treatment in India makes it a perfect destination for Adrenal Cancer treatment. The cost of treatment in India for Indian patients is between Rs. 266400 to Rs. 355200, and for International patients is between USD 5400 to USD 6600.
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Adrenal Cortex Tumors Include:
- Adrenocortical carcinoma (malignant or cancerous tumors): Very uncommon lesions with a worldwide incidence of 0.5 to 2 per 1 million people annually. These lesions are very aggressive and, in some cases, may be functional and present with Cushing syndrome and/or virilization.
- Adrenocortical adenoma (benign or non-cancerous tumors): Benign neoplasms of the adrenal cortex.
- Sex cord-stromal tumors: Rare type of tumor divided into:
- Granulosa cell tumor
- Leydig cell tumor
- Adenomatoid tumor: Benign neoplasms of the adrenal cortex.
- Mesenchymal and stromal tumors
- Myelolipoma: Benign neoplasms of the adrenal cortex
- Schwannoma
- Hematological tumors: Primary hematological tumors are mostly lymphomas and rarely plasmacytoma.
- Secondary tumors: Usually metastatic lesions due to direct infiltration by adjacent cancer or, more commonly, via hematogenous spread from a distant site.
What are the Symptoms of Adrenal Cancer?
- Weight gain
- Muscle weakness
- Pain in the abdomen or lower back
- Weight loss or loss of appetite
- Trouble sleeping
- Deepening voice
- Increased hair growth, usually on the face (in women)
What are the Risk Factors of Adrenal Cancer?
Adrenocortical carcinoma typically develops sporadically without a genetic link. In some cases, this cancer has been associated with genetic conditions, including:
- Li-Fraumeni syndrome
- Beckwith-Wiedemann syndrome
- Carney complex
- Lynch syndrome
- Multiple endocrine neoplasia, type 1 (MEN 1)
Stages of Adrenal Cancer
A staging system is used to describe the cancer spread. The standard staging systems [American Joint Committee on Cancer (AJCC) and the ENSAT (European Network for the Study of Adrenal Tumors)] are based on TNM categories.
- T - Denotes the size of the primary tumor and whether it has spread (metastasized) to nearby organs
- N - Indicates cancer spread to lymph nodes near the adrenal gland
- M - Denotes cancer's spread to distant sites, such as other organs or lymph nodes.
After determining the TNM category, it is combined with stage grouping to assign an overall stage (numbered I through IV). The lower the number, the less cancer has spread.
In stage I, the tumor size is 5 centimeters or smaller and is only found in the adrenal gland.
In stage II, the tumor is > 5 centimeters and is only found in the adrenal gland.
In stage III, the size of the tumor is variable, and it spreads to:
- Nearby lymph nodes; or
- Nearby tissues or organs (kidney, diaphragm, pancreas, spleen, or liver) or large blood vessels (renal vein or vena cava) may have spread to nearby lymph nodes
In stage IV, the tumor is of any size and may spread to nearby lymph nodes and other body parts, such as the lung, bone, or peritoneum.
Most cancers in the adrenal gland start in other organs or tissues and then metastasize through the bloodstream to the adrenal glands. For example, lung, melanoma, and breast cancers often spread to the adrenals. Cancer that spreads to the adrenals is named and treated based on where it started.
Diagnosis of Adrenal Cancer
Adrenal cancer can be diagnosed with the help of different tests and procedures, such as:
- Blood and urine tests: Laboratory blood and urine tests may diagnose exceptional levels of hormones produced by the adrenal glands, such as cortisol, aldosterone, and androgens.
- Imaging tests: The doctor may recommend CT, MRI, or positron emission tomography (PET) scans.
- Laboratory analysis of adrenal gland: If adrenal cancer is suspected, the doctor may recommend removing the affected part after the tissue analysis.
Treatment of Adrenal Cancer
Adrenal cancer treatment involves surgery to remove all of cancer. The doctors may use other treatment options to prevent cancer from recurring if surgery is not an option.
- Surgery: Adrenalectomy surgery removes the affected adrenal gland. If cancer spreads to nearby structures (e.g., liver or kidney), the doctor may remove parts of the affected organs during the operation. After surgery, mitotane (Lysodren) may be recommended for patients with a high risk of recurrence.
- Radiation therapy: Radiation therapy, such as X-rays and protons, is sometimes used after surgery to kill any remaining cancer cells. It helps reduce pain, cancer symptoms, and cancer spread to other body parts.
- Chemotherapy: For adrenal cancers that can not be removed surgically or that recur after initial treatments, chemotherapy may be an option to slow cancer progression.
Why Patients Choose India for Adrenal Cancer Treatment?
Cost: The average cost of medical treatment in India is less than in other Western countries.
The cost may vary depending on certain factors, such as:
- Doctor's experience
- Location of hospital
- Medication, if required
- An extended stay at the hospital
Latest technology: Cities like Delhi, Bangalore, Mumbai, and Hyderabad have state-of-the-art machines. The cancer hospitals in India have some of the finest machinery, such as:
- Da Vinci Robot is a highly accurate machine-assisted surgical tool
- Cyberknife surgery is a non-invasive and pain-free radiation machine with no side effects
- Proton Therapy, available in a few selected countries, is also available in India
International Accredited Hospitals: India has the highest number of NABH (National Accreditation Board for Hospitals & Healthcare) and JCI (Joint Commission International) accredited hospitals that provide healthcare facilities of international standards.
Shorter Waiting Times: The average waiting time for complicated surgical procedures is shorter in India than in other Western countries.
Best doctors: The top doctors in India are highly qualified and skilled with expertise in their field.
Top Doctors in India Providing Adrenal Cancer Treatment
- Dr. Ramesh Sarin: Dr. Ramesh Sarin is one of the most highly-experienced Surgical Oncologists with an experience of over 40 years. She is keenly interested in breast reconstructive surgeries and surgical management.
- Dr. Jalaj Baxi: Dr. Jalaj Baxi is a renowned Surgical Oncologist with over 28 years of experience. After completing his MS and DNB in General Surgery, he received a Diploma in Advanced Laparoscopic Oncologic Surgery in Japan.
- Dr. Vikram Pratap Singh: Dr. Vikram Pratap Singh is a highly-experienced Surgical Oncologist with over 35 years of experience. His clinical interest lies in Modern radiation techniquesClinical Oncology, Intensity Modulated Radiotherapy (IMRT), Stereotactic Radiotherapy and Radiosurgery, Image-Guided Radiotherapy (IGRT), 3-D Brachytherapy, Stereotactic Body Radiotherapy (SBRT), etc.
- Dr. Shabber S Zaveri: Dr. Shabber S Zaveri is a renowned Surgical Oncologist with an experience of over 28 years. He has expertise in Head & Neck Tumor Surgery, Lung Cancer Treatment, Breast Cancer Treatment, Mastectomy, etc.
- Dr. Sangram Keshari Sahoo: Dr. Sangram Keshari Sahoo is a highly skilled and internationally trained Surgical Oncologist with over 27 years of experience. His clinical interest includes head & neck oncology, thoracic oncology, GI & HPB oncology, breast and gynecological oncology, urological oncology, bone & soft tissue tumors, sentinel node biopsies, and HIPEC, among others.
Conclusion
If Adrenal Cancer is treated before spreading beyond the adrenal glands, the survival rate is 74% for at least five more years. That 5-year survival rate is 56% if cancer spreads to nearby tissues or organs and 37% if cancer has spread to more distant parts of the body.
Adrenal Cancer is managed by a radiation oncologist, surgeons, an oncologist, and an endocrinologist. An early diagnosis with prompt treatment results in an excellent prognosis for most patients.
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