The following are the procedures for the treatment of adrenal cancer.
1.Surgery for Adrenal Cancer
Adrenal cancer is mostly treated by removing the adrenal gland, a procedure known as an adrenalectomy. The surgeon will attempt to remove as much cancer as possible, including any locations where the disease has spread. If surrounding lymph nodes are swollen, they must be removed and examined for cancer spread. An incision in the back, right behind the ribs, is one method for removing the adrenal gland. This works well for tiny tumours, but bigger tumours might be difficult to notice. Typically, the incision is made through the front of the abdomen by the surgeon. This allows the surgeon to examine the tumour more clearly and determine whether it has spread. It also allows the surgeon to remove a big tumour that has spread to other tissues and organs. For example, if the cancer has spread to the kidney, the entire or a portion of the kidney must be removed. If cancer has spread to the muscle and fat around the adrenal gland, these tissues mu st also be removed.The malignancy can sometimes spread to the inferior vena cava, a major vein that transports blood from the lower body to the heart. If this is the case, removing the tumour while preserving the vein will necessitate a lengthy procedure in order to remove the tumour from the vein, the surgeon may need to bypass the body’s circulation by placing the patient on a heart-lung bypass machine, similar to that done in heart surgery. If the cancer has spread to the liver, the portion of the liver harbouring the cancer may also need to be removed.
Some small adrenal tumours can also be removed using a laparoscope, which is a narrow hollow, illuminated tube with a tiny video camera on the end. Instead of a big incision in the skin, many tiny ones are made to remove the tumour. The laparoscope is inserted via one of them by the surgeon. This allows him or her to look inside the stomach. The adrenal gland is then removed using additional tools introduced via this tube or through other tiny incisions. The major advantage of this approach is that patients recover from surgery faster since the incisions are smaller. Although laparoscopic surgery is utilized to treat benign tumours such as adrenal adenomas, it is not always a choice for treating bigger tumours such as adrenal cancer. This is due to the need of removing the tumour in one piece whenever feasible. To remove a big tumour with a laparoscope, the surgeon may need to first cut it up into little pieces. This increases the likelihood of the cancer spreading. Adrenal tumours that have spread to adjacent tissues or lymph nodes might also be difficult to entirely remove using laparoscopy.1.
Radiation Therapy for Adrenal Cancer
Radiation treatment kills cancer cells by using high-energy x-rays (or particles). Because cancer cells are difficult to destroy with x-rays, radiation therapy is rarely utilised as the primary first treatment for adrenal cancer. Radiation may be given after surgery to help prevent the tumour from returning. This is known as adjuvant treatment. Radiation can also be used to treat regions where cancer has spread, such as the bones or the brain.
External beam radiation therapy utilises a machine outside the body to direct radiation to the tumour. Treatments are frequently administered once or twice a day, five days a week for several weeks. Treatment is painless and similar to obtaining an x-ray. The actual treatment duration is only a few minutes, but the setup time – putting you into position for treatment – generally takes longer to ensure that the radiation is correctly directed at the tumour.Before beginning treatment, the radiation team will take precise measurements to determine the optimum angles for directing the radiation beams and the appropriate amount of radiation. This simulation session generally includes having imaging tests such as CT or MRI scans.Brachytherapy (internal radiation therapy) involves the placement of tiny radioactive pellets adjacent to or directly into the malignancy, sometimes in thin plastic tubes. The pellet-containing tubes are kept in situ for a few days before being removed. The exact time is dependent on the radioactive pellet strength and the size of the tumour.
Chemotherapy for Adrenal Cancer
Chemotherapy (chemo) is the use of certain medicines to treat cancer. Typically, the medicines are administered intravenously or orally (in pill form). Because these medicines enter the circulation and travel throughout the body, this treatment is effective for cancer that has spread (metastasized) to organs other than the adrenal gland.Chemotherapy does not function well for adrenal cancer, thus it is usually reserved for cases when the disease has progressed too far to be removed surgically.
Mitotane is the most commonly prescribed medication for patients with adrenal cancer. It inhibits the adrenal gland’s hormone production while simultaneously destroying both cancerous and healthy adrenal tissue. This medication can also decrease the natural synthesis of adrenal steroid hormones by your other, normal adrenal gland. This might result in low cortisol and other hormone levels, making you feel weak and ill. If this happens, you’ll need to take steroid hormone tablets to restore your hormone levels. Mitotane can also affect the levels of other hormones including thyroid hormone and testosterone. If this happens, you’ll need medications to replenish these hormones as well. Mitotane is sometimes administered for a length of time after surgery has eliminated all visible malignancy. Adjuvant treatment is used to destroy any cells that were left behind but were too tiny to notice. Giving the medication in this manner may prevent or postpone the recurrence of the malignancy.
Metyrapone and ketoconazole can both decrease the synthesis of adrenal steroid hormones. This may alleviate symptoms produced by these hormones, but it does not decrease the tumour.
Some medicines work by blocking the impact of the tumor’s hormones
- Spironolactone (Aldactone), which decreases effects of aldosterone
- Mifepristone (Korlym), which decreases cortisol effects
- Tamoxifen, toremifene (Fareston), and fulvestrant (Faslodex), can block the effects of estrogen. These drugs are more often used to treat breast cancer, but can be useful in some patients (often men) who have adrenal tumors that make estrogen.