Metastases to the adrenal gland
There are many strategies to treat adrenal metastasesMetastases - cancer that has spread from another part of the body:
Treat the underlying cancer
The most effective way to treat an adrenal metastasis is usually to treat the underlying cancer. For many patients, this involves treatment with systemic therapy (chemotherapy, targeted therapy, immune therapy). Systemic therapy uses drugs to kill cancer cells or keep them from growing. Systemic therapy drugs are usually given intravenously (through a vein into the bloodstream), but are also sometimes given by mouth. Since metastasis to the adrenal gland is usually a sign of an aggressive cancer that has a high risk of spreading to other parts of the body, systemic therapy has the advantage of potentially treating cancer cells not only in the adrenal gland, but also in other organs where they may be hiding.
Some patients with adrenal metastasis are able to take part in studies, called clinical trials, which test new treatments. These treatments may include new drugs or new combinations of different drugs. The National Cancer Institute lists information about ongoing clinical trials at its web site at www.cancer.gov. You may also find information regarding clinical trials at www.centerwatch.com.
Manage adrenal insufficiency, if present
Since the adrenal glands are paired organs, patients with cancer involving a single adrenal gland do not develop adrenal insufficiency. However, patients with bilateral adrenal metastasis may develop adrenal insufficiency. Testing for adrenal insufficiency in such patients should be considered (blood tests including cortisolCortisol - a glucocorticoid that controls glucose production and suppresses the immune system and ACTH levels). For patients with signs and symptoms or laboratory evidence of adrenal insufficiency, replacement doses of steroid hormones can be provided as a medication taken either by mouth or intravenously.
Treat the adrenal metastasis
Specific treatment of an adrenal metastasis to include radiation therapy or surgery is sometimes recommended.
Radiation therapy Uses x-rays or other high-energy rays to kill cancer and prevent tumors from growing. Radiation therapy has commonly been used, for example, to treat adrenal metastasis from lung cancer. Radiation therapy can be effective for this purpose, although kidney function on the side of the radiation may worsen due to the fact that the adrenal gland and the kidney are next to each other.
Adrenalectomy AdrenalectomyAdrenalectomy - an operation to remove the adrenal gland is sometimes recommended for patients with an adrenal metastasis. Often, the operation can be done using minimally invasive techniques such as laparoscopic adrenalectomy. (See How is adrenal surgery performed?) Adrenalectomy may be the best treatment for patients with a metastasis to the adrenal gland if:
- The primary site of the cancer is controlled (i.e. there is no evidence of local recurrence of the cancer)
- There is no evidence of metastasis elsewhere in the body (i.e. the adrenal gland is the only site of metastasis)
- The overall rate of spread of the cancer is relatively slow (doctors sometimes prefer there to be a time period of approximately one year or more between the last evidence of cancer and the development of the adrenal metastasis)
- There is a reasonable expectation that the entire tumor can be removed (i.e. imaging studies suggest there is limited involvement of nearby organs such as kidney, liver, spleen or pancreas)
- The patient is in good enough health that they will recover relatively rapidly from the operation.