Adrenal Gland Cancer

The adrenal glands, called “adrenal”, are internal secretion glands that resemble a triangle shape. The adrenal glands, so named because they are anatomically located just above the kidneys, are located in the front-upper part of the kidneys, behind the abdominal membrane called "retroperitoneum". There is fatty tissue around it and the kidney membrane called "Gerota fascia" surrounding this fatty tissue. They consist of two separate layers: the shell layer called "cortex" and the inner layer called "medulla". Its main function is to produce corticosteroids from the shell layer and catecholamines from the inner layer and secrete them into the blood.

The shell layer is the vital area of ​​the gland. It produces hormones called "cortisol", "aldosterone" and "androgens" under the influence of the ACTH hormone, which is secreted from the pituitary gland and mixed into the blood. These hormones ensure the body's water and salt balance, control blood pressure, regulate protein, fat and carbohydrate metabolism and control the production of sex hormones.

The inner layer produces substances such as adrenaline and noradrenaline called "catecholamines", which are the body's hormones. It is responsible for regulating the response to physiological tension (stress).

What is adrenal gland cancer?

As the name suggests, "adrenocortical cancer" is the shell of the adrenal gland. It is a very rare (5-20 in 10,000,000) type of cancer that originates from the cervix. It can be seen at any age, but it most often occurs in children under five years of age and in adults aged 40-50. It is an aggressive cancer that progresses and spreads rapidly. Spread occurs when the cancer reaches the surrounding tissues directly or when cancerous cells are transported to distant areas via lymph and blood vessels. If detected early, treatment is possible. However, if the cancer has spread or spread beyond the adrenal gland, the chance of treatment is very low. Drug treatments can only be used to delay the progression and recurrence of the disease.

Cancers detected in the adrenal gland can be functional, that is, producing hormones, or non-functional, that is, not producing hormones. Functional cancers cause different complaints depending on the hormone produced.

Not all masses detected in the adrenal gland may be malignant. “Adenoma” and Some tumors called “pheochromocytoma” are benign.

What are the causes?

The cause is not exactly known. It has been determined that the incidence increases in some genetic diseases.

• Li-Fraumeni Syndrome

• Beckwith-Wiedemann Syndrome

• Carney complex

• Multiple Endocrine Neoplasia Type 1

• McCune-Albright Syndrome

  >

How does it cause symptoms?

Nowadays, with the widespread use of health screenings, there is an increase in adrenal gland masses detected incidentally. However, the majority of patients with adrenal gland cancer still present with advanced disease and tumor-related complaints arising from the size of the mass or secreted hormones. Non-functional cancers do not cause complaints in the early stages. 50-79% of adult adrenal gland cancers and 90% of childhood adrenal cancers are functional, that is, hormone-producing cancers.

If cortisol production is high;

• Weight gain on the face, neck and trunk, weight loss in the arms and legs

• Increased hair growth on the face, back and arms in women

• Round and red face

• Increase in fat mass in the back and back of the neck

• Muscle weakness

• Increase in blood pressure

• Increase in blood sugar

• Voice deepening

• Loss of sexual desire

If aldosterone production is high;

• Increase in blood pressure

  >

• Muscle weakness and cramps

• Increased frequency of urination

• Increased feeling of thirst

If testosterone production is high;

• It does not usually cause complaints in men

• Increased hair growth on the face, back and arms in women

• Acne

• Balding

• Voice deepening

• Stopped menstrual bleeding

If estrogen production is high;

• Menstrual bleeding in pre-menopausal women irregularity

• Resumption of menstrual bleeding in post-menopausal women

• Enlargement of breast tissue in men

• Decreased sexual desire in men

• Erectile disorders in men

Non-functional cancers, that is, cancers that do not produce hormones, are more general complaints. They present with.

• Abdominal pain

• Back pain

• Abdominal mass

• Nausea

• Vomiting

How to diagnose Is it placed?

Patients who apply due to complaints or a mass detected in radiological examinations performed for another reason are evaluated with detailed physical examination, medical history and laboratory tests.

Adrenal Gland. Diagnostic Tests for Cancer

• Physical Examination and Medical History

• Blood and Urine Analysis: Blood and Urine Analysis Urine samples are taken to investigate whether there are abnormalities in the hormone levels produced by the adrenal gland. Blood electrolyte levels are evaluated.

• Radiological Imaging Methods: Imaging methods such as computerized tomography, magnetic resonance imaging, PET determine the location and size of the cancerous tissue, its relation to surrounding tissues. It is evaluated whether it has spread to distant areas or not.

• 24-Hour Urine Analysis: It is performed to investigate whether the mass is functional or not. This test is performed by measuring the amount of cortiol and catecholamines in the urine collected for 24 hours.

• Dexamethasone Suppression Test: It is performed to investigate whether the mass is functional or not. ACTH hormone secreted from the pituitary gland is suppressed by administering a substance called "dexamethasone" that has a similar effect to cortisol secreted from the adrenal gland. In normal people, as ACTH secretion decreases, cortisol secreted from the adrenal gland also decreases. In cancerous tissues, this suppression response does not occur and cortisol production continues.

• Adrenalectomy: When cancer suspicion arises, the adrenal gland is surgically removed and pathologically examined. t

Determining the Stage of Adrenal Cancer

After the diagnosis of adrenal cancer is definitively established, the next step is to determine the spread of the cancer. This study is called cancer staging. For this purpose, additional radiological imaging methods and examinations may be used.

• Computed Tomography

• Magnetic Resonance Imaging

• Adrenal Angiography

• Adrenal Venography

• Kavagram

• Ultrasonography

• Adrenalectomy

Staging in adrenal cancer is as follows.

• Stage 1: The cancerous tissue is smaller than 5 cm and is only within the adrenal gland.

• Stage 2: The cancerous tissue is larger than 5 cm and is only within the adrenal gland. It is inside the gland.

• Stage 3: The cancerous tissue has spread to the fatty tissue or lymph nodes around the adrenal gland.

• Stage 4 : Cancerous tissue has spread to surrounding organs such as fatty tissue, lymph nodes and kidney around the adrenal gland, or to distant organs such as liver, lung, bone and peritoneum.

How is it treated?

Unfortunately, approximately 50% of patients with adrenal cancer have advanced cancer. The risk of recurrence and spread of the disease is quite high in these patients. Therefore, patients should be followed and treated by a team consisting of a surgeon, medical oncologist, radiation oncologist and endocrinologist. Despite appropriate surgical treatment, there is a 60-80% risk of disease recurrence.

There are different treatment options for adrenal cancer treatment, including standard treatments and experimental treatments. Standard treatment methods are as follows.

• Surgical Treatment: The aim of the surgical approach called "Adrenalectomy" is to completely remove the cancerous tissue and the lymph nodes around this tissue. In cases of advanced cancer, even if the cancerous tissue cannot be completely removed, removing more than 90% of it can alleviate cancer-related side effects and increase the effectiveness of additional treatments. In case of recurrence of the disease, re-infection in the operation area Surgical removal of the resulting cancerous tissue and cancerous tissue in distant areas increases the chance of survival.

• Radiotherapy: The role of radiation therapy in adrenal gland cancer is limited. However, if there is bone and brain spread, it may be a treatment option. The risk of recurrence of the disease can be reduced by radiotherapy applied following the removal of cancer in the adrenal gland.

• Chemotherapy: It is used to kill cancer cells. An attempt is made to stop the recurrence and progression of the disease with an oral medication called "Mitotoan".

_{Read: 0}