Treatment

U-M endocrine oncology team members treat patients with adrenal cancer aggressively and with state of the art techniques. The team consistently pursues new therapies to provide patients with the best care possible and best chances for survival.

If an adrenal nodule is found, the team wants as much information as possible to develop an individualized treatment plan. The team will evaluate the nodule by obtaining a CT scan or MRI done specifically to look at the adrenal glands. Our team prefers to investigate adrenal abnormalities using CT first, and MRI if a different type of study is needed. Patients also have blood drawn and submit urine samples (drawn over 24 hours) to test for excess amounts of adrenal hormones. Other laboratory studies may be obtained depending on individual patient findings.

In some instances, patients are referred to one of U-M's genetic counselors for potential further genetic testing. For more information, please visit the Cancer Genetics Clinic.

Surgery

Surgery is the first choice of treatment for adrenal cancer, when possible. In many cases, the tumor has spread to other organs in the body or invaded structures that cannot be removed, in which case surgery is not an option. Patients who can have surgery should seek out a surgeon experienced in adrenal cancer.

Adrenal cancer must be carefully and completely removed, and. appropriate evaluation and planning is critically important. During surgery, the covering of the tumor must not be penetrated. A wide margin of normal tissue around the tumor should also be removed to ensure that the surgeon gets all of the cancer. This minimizes the chance that the cancer will recur.

Based on recent research at the University of Michigan, it is not recommended to have any potentially cancerous adrenal mass or nodule removed laparoscopically.

Laparoscopic surgery uses specialized tools and cameras inserted through small incisions. It is thought that laparoscopic instruments rub against the tumor and spread tumor cells to other parts of the abdomen, leading to early recurrence. Often, when a procedure is performed laparoscopically, the entire tumor is not removed, and the edges of the tissue removed are positive for tumor cells. This is called positive margins and means that some cancer cells could still remain in the body.

An open approach to surgery, which uses a larger incision along the rib cage or along the midline of the abdomen, allows the surgeon to remove a rim of normal non-cancerous tissue around the tumor more easily, which helps decrease the likelihood of the cancer recurring.

Surgical Follow-Up Care

After surgery, the U-M multidisciplinary tumor board will review surgical findings and the pathology report. Important aspects of the pathology report include:

  • Whether the entire tumor was removed
  • If the margins are positive or negative
  • If the cancer has invaded the capsular or vascular
  • Whether the tumor is low or high grade
  • If any cancer is seen within lymph nodes
  • If cancer has spread into nearby structures

Decisions about further treatment will depend on the answers to these questions. Other treatments may include one or more of the following:

If Mitotane is prescribed, mitotane levels, thyroid function and liver function will be checked frequently through blood tests, and replacement steroids will also be started.

U-M physicians will work closely with a patient's primary care physician and other physicians near their home to ensure they are receiving optimal care. For those with persistent or recurrent disease, U-M physicians will aggressively pursue all treatment options, including any new clinical trials offered.

Still have questions?

The nurses at Cancer AnswerLine™ have answers. Call 1-800-865-1125 and you'll get a personal response from one of our registered nurses, who have years of experience in caring for people with cancer.

 

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