Adrenocortical carcinoma

Each kidney has a single adrenal gland on top of it. Adrenocortical carcinoma (ACC) is a type of cancer that develops in the outer layer (cortex) of the adrenal glands.

The adrenal cortex produces hormones like cortisol, testosterone, aldosterone, and oestrogen. These hormones regulate male and female characteristics as well as internal functions such as blood pressure and stress response. There are two types of ACC. Functioning ACC tumour which causes the adrenal gland to make more hormones than it normally should and non-functioning ACC tumour which doesn’t affect hormone production.

Signs and Symptoms

Adrenal tumours produce symptoms in two ways:

A functional ACC might generate symptoms associated with hormone overproduction.

If the adrenal tumour gets enlarged, it may push on other organs nearby. This pressure might result in discomfort and other symptoms. Depending on the aetiology, adrenocortical cancer symptoms may include:

  • Pain in the abdomen (belly).
  • Gynecomastia (excessive breast growth in boys or men).
  • Early puberty in both males and girls.
  • Excessive face or body hair growth in women.
  • High blood pressure
  • High blood sugar levels.
  • Gain in body weight, but only in the face, neck, and trunk (not the arms or legs).

Diagnosis

Imaging tests, like computed tomography (CT) scan, magnetic resonance imaging (MRI), or positron emission tomography (PET) scan to look for tumours.

Blood and urine examination to check hormone levels.

A dexamethasone suppression test to measure the cortisol levels.

A biopsy is used to assess whether a tumour is malignant.

Staging

If a biopsy confirms that the adrenal tumour is cancerous, the doctor will establish the degree of the disease by staging by measuring the tumour to see if cancer cells have moved beyond the adrenal gland to other places in the body.

  • Early adrenal cancer at its stage 1 or stage 2, the tumour is still rather small and hasn't progressed outside the adrenal gland.
  • Advanced adrenal cancer that has spread to stages 3 and 4 of adrenal cancer indicates that the tumour has migrated to other bodily regions. Typically, cancer cells spread first to nearby lymph nodes. Additionally, advanced cancer can spread to other tissues, blood vessels, bones, and organs.

Treatment

Typically, surgery is the primary course of therapy to remove the tumour. The treatment strategy may involve radiation, chemotherapy, or immunotherapy to prevent malignant cells from spreading to other parts of your body.

Prognosis

The prognosis is determined by the tumour’s size, location, and whether it has spread outside of the adrenal glands. The prognosis is better in younger persons or when the tumour is small.

In some cases, surgically removing the tumour can cure cancer. Tumours that have spread to other regions of the body are more difficult to cure.