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Adrenocortical cancer

Sep 1, 2019

Adrenocortical cancer is a malignant tumor of the adrenal glands. 

The most pronounced manifestation of adrenal cancer is Cushing's syndrome, which is characterized by the following changes in the human body: 

  • Fat deposits on the torso, especially on the back of the neck
  • Upper arm muscle weakness  
  • Muscle weakness of the upper legs, 
  • Thinning of the skin, 
  • Hair growth in a woman on the face and body as in a man, 
  • It is also possible to develop diabetes. 

Such symptoms occur in both benign and malignant tumors.

Pheochromocytomas produce substances that affect blood pressure and stress responses, so they can cause a variety of symptoms, such as: 

  • Sudden attack of sweating
  • Fainting (loss of consciousness)  
  • Mood changes
  • Rapid heartbeat
  • Headaches  
  • Unpleasant sensations in the chest  
  • Thirst
  • Increased urination

In addition, the adrenal aldosteroids can produce hormones that also affect blood pressure and potassium levels in the body.

Diagnosis of adrenal cancer:

There is an algorithm for hormonal examination of patients with suspected adrenocortical cancer, which includes the determination of the following indicators in the blood and in the urine:

- cortisol

- cortisol after an overwhelming dexamethasone test

- ACTH

- DHEA-sulfate

- 17-hydroxyprogesterone

- androstenedione

- testosterone

- estradiol

- analysis of daily urine for cortisol and metanephrine

- if the patient has high blood pressure or hypokalemia (low potassium content in the blood), it is also necessary to include in the blood test the determination of the level of aldosterone and renin.

- a test for cancer markers is performed to determine the proteins produced by tumors that are not present in a healthy body.

The basic plan of instrumental diagnostics includes:

1) Computed tomography (CT), which allows you to clarify the nature of the pathology, as well as to control the growth and spread of the tumor.

2) Magnetic resonance imaging (MRI) the abdominal cavity is used to diagnose adrenal cancer and detect metastases.

Sometimes other additional studies are prescribed: 

3) Adrenal angiography is designed to detect any abnormalities in the blood flow. It is an X-ray examination of the blood vessels located in the area of the adrenal glands.

4) Phlebography of the adrenal glands, which allows you to examine the veins located within the adrenal glands, in order to detect abnormalities in the blood flow.

5) Positron emission tomography (PET) - a study to determine the presence of metastases.

6) Scintigraphy (radioisotope research) - the introduction of a special drug into the body, which contains labeled atoms. They accumulate in large quantities in the tumor tissues and can be detected by a special device.

7) A biopsy and histological examination of a piece of adrenal tissue, which can confirm the malignant nature of the tumor or refute the diagnosis of "cancer".

With timely diagnosis of adrenal cancer, the prognosis is relatively favorable.

Surgical and combined treatment of adrenal cancer

In all cases, the tumor is removed surgically. The operation is called an adrenalectomy-removal of the affected adrenal gland.

With a small tumor size, it is possible to perform endoscopic (laparoscopic) surgery to remove adrenal cancer. Traditional open-access surgery allows the most complete examination of the abdominal cavity and retroperitoneal space, perform a thorough lymph node dissection( removal of the affected lymph nodes), reduce the risk of damage to the tumor capsule and the associated spread of metastases in the peritoneum.

An important stage of surgery for adrenal cancer is preventive lymph node dissection-removal of retroperitoneal lymph nodes, which increases the survival rate of patients and reduces the risk of tumor recurrence.

Also, for adrenal cancer, doctors can use radiofrequency ablation. The tumor is affected by radio frequency waves, which are converted into heat, and the tumor cells are destroyed as a result of heating the diseased tissue.

As an additional postoperative therapy, all patients with adrenal cancer are recommended to undergo chemotherapy, which is selected by an oncologist. 

Diagnosis and treatment of adrenal cancer should take place with the participation of an endocrinologist, oncologist and surgeon in a specialized department.

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