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Treatment for adrenal cortical carcinoma

The main treatments for adrenal cortical cancer (ACC) are surgery, radiotherapy and chemotherapy.

Your treatment depends on:

  • the size of the tumour
  • whether it has spread
  • your general health and fitness

Unfortunately, ACC can be quite a fast growing type of cancer. It is often diagnosed in the later stages when it is quite advanced. This means it can be difficult to cure.

Surgery

Surgery to remove the affected adrenal gland is usually the first choice of treatment if you have an early stage cancer. This can cure the cancer. This operation is called an adrenalectomy.

Your surgeon might also remove the tissues and lymph nodes immediately surrounding the adrenal gland. They might do this if they think the cancer might have spread into the surrounding area.

In some cases, your doctor may suggest surgery for ACC that has spread. This is usually if there are only 1 or 2 small well contained areas.

Hormones

Hormones produced by the cancer can make your blood pressure unstable so it can change suddenly during and immediately after the operation. To make sure it is as stable as possible, you might need to take blood pressure medicines from around 10 days before the operation. After surgery, your blood pressure should go back to normal.

Following an adrenalectomy, your other adrenal gland should carry on making all the hormones you need.

You will have to take hormone replacement tablets if you have both adrenal glands removed. You have these every day for the rest of your life.

Radiotherapy

External radiotherapy uses specialised radiotherapy machines to aim radiation beams at a cancer.

Doctors most often use external radiotherapy for ACC that has spread. It can be very useful for treating symptoms of cancer that has spread to the bones.

You might have radiotherapy for earlier stage ACC after surgery. 

Chemotherapy

Chemotherapy uses anti cancer drugs to destroy cancer cells. Doctors usually use chemotherapy to treat ACC that has come back or spread to other parts of the body. You might have just one drug or a combination of more than one drug.

The most common drug for ACC is mitotane (Lysodren). As well as destroying the cancerous adrenal cells, it also blocks the production of hormones by the tumour. You might have mitotane

  • to help control troublesome symptoms caused by excess hormones 
  • after surgery to reduce the chances of the cancer coming back.

Mitotane

Mitotane can have a lot of side effects. So if you have this treatment, you have blood tests to check you are having the right dose for you. 

Mitotane often stops your body producing hormones. So you will need to take hormone replacement medicines. Your doctor can tell you more about this.

Other chemotherapy drugs

Some of the other chemotherapy drugs used to treat adrenal cortical cancer are:

  • cisplatin
  • doxorubicin (Adriamycin)
  • paclitaxel (Taxol)
  • fluorouracil (5FU)
  • vincristine
  • etoposide (VP16

You usually have 2 or more of these drugs together. For example etoposide, doxorubicin and cisplatin. You may have this combination of drugs with mitotane. 

Research into treatment

Researchers and doctors around the world are continually trying to improve treatments for adrenal cortical cancer. But because this type of cancer is so rare, it makes it difficult to carry out trials. 

Researchers are also looking to see if different types of targetted treatments are helpful for ACC. There have been mixed results so far.

Coping

Coping with a diagnosis of a more aggressive cancer can be especially difficult, both practically and emotionally. Being well informed about your cancer and its treatment can make it easier to make decisions and cope with what happens.

Talking to other people who have the same thing can also help.

Our discussion forum Cancer Chat is a place for anyone affected by cancer. You can share experiences, stories and information with other people who know what you are going through.

The Rare Cancer Alliance offer support and information to people affected by rare cancers.

Last reviewed: 
20 Jun 2018
  • Cancer and its management (6th edition)
    J Tobias and R Hochhauser
    Wiley Blackwell, 2010

  • Combination chemotherapy in advanced adrenocortical carcinoma
    M. Fassnacht (and others)
    New England Journal of Medicine. 2012 Jun 7;366(23):2189-97

  • Principles and practice of oncology (10th edition)
    VT. De Vita, S. Hellman, and SA.Rosenberg
    Walters Kluwer, 2015

     

  • Adrenal cancer: ESMO Clinical Practice Guidelines
    A. Berruti and others
    Annals of Oncology 2012; 23 (Suppl 7): vii131-vii138.

  • European Society of Endocrine Surgeons (ESES) and European Network for the Study of Adrenal Tumours (ENSAT) recommendations for the surgical management of adrenocortical carcinoma
    S. Gaujoux and others
    BJS 2017; 104: 358–376

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