Most growths in the adrenal glands are not cancer. These noncancerous tumors often cause no symptoms and do not require treatment. 

Adrenal cancer, because it is so rare, is usually discovered on scans for other conditions.

What is adrenal cancer?

Adrenal cancer occurs when cells grow out of control in an adrenal gland, most often on the outer layer called the cortex. 

Your two adrenal glands are about the size of golf balls. They sit high in your midsection, one above each kidney. 

They make hormones that help your body:

• Manage stress
• Regulate blood flow
• Help your kidneys function
• Help regulate feminine and masculine traits

Some people are diagnosed with adrenal cancer after they notice changes related to these hormones. Others find out they have it after imaging tests such as X-rays or MRIs.

Who gets adrenal cancer?

Adrenal cancer is diagnosed in fewer than one in 1 million people a year in the U.S. 

Researchers don’t know what causes most adrenal cancers, though they have identified risk factors:

• Adrenal cancer mainly affects two age groups: children younger than 5 and adults ages 40 to 50. It is slightly more common in women than in men. Learn about OHSU’s expert care for children with cancer or an endocrine condition.
• Researchers have not found a genetic link to adrenal cancer. Patients with certain inherited disorders may have a higher risk, though. They include: 
  • Multiple endocrine neoplasia
  • Beckwith-Wiedemann syndrome
  • Li-Fraumeni syndrome

OHSU offers genetic assessment and testing to help you identify and manage risk. 

Adrenal cancer survival rates

A key concept in understanding survival is five-year relative survival rate. This is the percentage of people who are still alive five years after they were first diagnosed, compared to the general population. (It doesn’t count death from other causes.)

The five-year relative survival rate for adrenal cancer is 73% if it is caught before it spreads, according to the American Cancer Society.

It's important to remember that survival rates are averages and can't predict the outcome for any one patient. It's also important to remember that they are based on the treatments that were available more than five years ago. Patients who are diagnosed now may have a better outlook. Treatments are getting better all the time.

Symptoms

Adrenal cancer may grow for years before you notice symptoms. Some patients report pain or pressure in the back or side. Common symptoms are often linked to changes in hormone production. These include:

• High blood pressure or elevated heart rate
• Anxiety, depression or other mood changes 
• Weight gain 
• Weakness in the legs
• Developing a shoulder hump 
• Blue or purple stretch marks on the abdomen
• Early puberty in children
• Facial hair growth in women
• Breast development in men

Diagnosing adrenal cancer

Tests may include:

Medical history and exam: You will be asked about your health history and your family’s history of cancers or genetic disorders. A physical exam will help your team understand your symptoms and check for growths in your abdomen. Your exam may also include X-rays. 

Blood and urine tests: Your care team may recommend blood or urine tests to check the levels of hormones made by the adrenal glands. Hormonal changes do not always indicate cancer, though, because some noncancerous adrenal tumors also release hormones.

CT scan: A computed tomography scan is similar to an X-ray but captures more detailed cross-section images. CT scans can clearly show small tumors and help your care team decide if surgery is a good option.

Ultrasound: Ultrasounds use sound waves to create images. Ultrasounds are faster and less expensive than other tests but may not show whether a growth is cancer. 

MRI: Magnetic resonance imaging scans use magnets and radio waves to take pictures inside the body. An MRI produces sharp, detailed images that can help determine if an adrenal tumor is cancer.

PET scan: For a positron emission tomography scan, you have an injection of radioactive sugar near the tumor. Cancer cells consume sugar faster than normal cells, so a PET scan looks for areas where the sugar is concentrated.

Types of adrenal tumors

Adrenal tumors generally fall into these categories:

Tumors of the adrenal cortex: Tumors found in the outer area of the adrenal glands, called the adrenal cortex, may or may not be cancer. Noncancerous tumors, called adenomas, are the most common type. Cancerous tumors are called adrenocortical carcinomas or adrenal cortical carcinomas. They are rare, affecting just a few hundred people in the U.S. each year.

Tumors of the adrenal medulla: Tumors found inside the adrenal gland, called the adrenal medulla, are uncommon. One type, pheochromocytoma, can cause high blood pressure, an elevated heart rate, flushing and sweating. About 10%  of pheochromocytomas contain cancer cells and may spread to other parts of the body. Neuroblastoma, a cancer of nerve tissue, may be found in the adrenal gland. It’s rare in children older than 10.

Other types of adrenal tumors: Most adrenal tumors are not cancer. You might hear them referred to as incidentalomas if they’re found during a test for an unrelated condition. One type, an aldosteronoma, can cause high blood pressure and lower potassium. Cushing’s disease also may result from noncancerous adrenal tumors.

Adrenal cancer staging

Staging helps your doctors understand the extent of cancer so they can make the best treatment recommendations. Your care team will also take into account your cancer’s grade, or how aggressive it looks under a microscope. Abnormal cells tend to be more aggressive.

This is staging for cancer of the adrenal cortex, the most common type of adrenal cancer.

Stage I: The tumor is no bigger than 5 centimeters and has not spread outside the adrenal gland.

Stage II: The tumor is larger than 5 centimeters and has not spread outside the adrenal gland.

Stage III: One of the following: 

• The tumor is larger or smaller than 5 centimeters and has spread to nearby lymph nodes. 
• The tumor is any size and has spread to tissue next to the adrenal gland, and may or may not have spread to nearby lymph nodes.
• The tumor is any size and has spread to nearby organs (kidney, diaphragm, pancreas, spleen or liver) or large blood vessels. Cancer may or may not have spread to nearby lymph nodes.

Stage IV: Cancer has spread to a distant part of the body.

Treatments

At the OHSU Knight Cancer Institute, our doctors are trained in the latest treatments for all types of adrenal tumors. They also work in teams and gather in meetings twice a month to share expertise across specialties. 

Surgery is the most common treatment for tumors contained within the adrenal gland. Cancer that has spread beyond the gland may be treated with surgery followed by radiation therapy or chemotherapy. 

Surgery

Radiation therapy

This therapy uses high-energy beams to penetrate deep into the body to kill cancer cells. Your body’s healthy cells are also sensitive to radiation, but normal cells can repair radiation damage and cancer cells cannot. Radiation therapy may be used after surgery for adrenal cancer to kill any cancer cells left behind.

Chemotherapy

Chemotherapy uses medications to kill cancer cells circulating nearly anywhere in your body. For adrenal cancer, medications may be given in a pill or a slow IV drip called an infusion. Chemotherapy may be used after surgery to kill remaining cancer cells or to manage symptoms of advanced adrenal cancer.

Additional OHSU services

• OHSU is Oregon’s only academic health center, giving us a strong research focus. Our work includes clinical trials to test promising new treatments. Look for an OHSU clinical trial for adrenal cancer.
• Read about OHSU’s cancer registries, including one for patients who have had adrenal cancer. Registries offer a chance to help research and receive updates.

Learn more

• Adrenal Cancer, American Cancer Society.
• Adrenocortical Carcinoma Treatment, National Cancer Institute
• Adrenal Cancer, Genetic and Rare Diseases Information Center, National Center for Advancing Translational Sciences 
• Discussion board for rare cancers, Cancer Survivors Network, American Cancer Society