Surgery

Surgery to remove the tumor (when feasible) is the most common primary treatment for adrenal cancer. In an adrenalectomy, the doctor removes the tumor with the adrenal gland, and possibly nearby lymph nodes. The doctor may operate through an incision in the back, abdomen, or chest, depending on the extent of the tumor. For smaller tumors, the doctor will usually make an incision in the back or side. For larger, more advanced tumors, the doctor usually makes an incision in the abdomen. This approach allows the surgeon to thoroughly examine the tumor, as well as all nearby organs, lymph nodes, and blood vessels. Occasionally, there is a need to remove surrounding organs partially or completely when there is a tumor invading the surrounding structures (kidney, colon, liver, pancreas spleen.) The doctor may also be able to remove the adrenal glands laparoscopically, making only three or four small incisions in your back, abdomen, or side and passing surgical instruments through the cuts to remove the malignant gland. This laparoscopic approach is often discouraged if there is suspicion for adrenal cancer.

Radiation Therapy

Radiation therapy uses high-energy rays produced by a machine to kill cancer cells. Radiation therapy is not used as a main treatment for adrenal cancer, but may be given after surgery (adjuvant therapy) to kill any microscopic cancer cells present, suspected, or palliatively to shrink the tumor and relieve the symptoms.

Chemotherapy

Chemotherapy uses cancer-killing drugs to destroy cancer cells or to slow the growth of rapidly multiplying cancer cells. Most of these medications are given through the vein (intravenously) and some are given by mouth (orally). Chemotherapy is generally not highly effective in treating adrenal tumors, but is often used for widespread adrenal cancer that has grown into nearby structures or spread to other parts of the body. It may also be combined with radiation therapy and used adjuvantly (after surgery) to kill microscopic cancer cells present or suspected.  Mitotane is given orally and it is the only approved drug to treat advanced adrenal cancer. It is often combined with intravenous chemotherapy to increase the chance of disease control

Other Medications

The doctor may recommend different medications to block the effects of hormones produced by the tumor. These medications do not shrink the tumor or cure the disease, but may help relieve symptoms caused by high levels of these hormones.

Clinical Trials

Clinical trials allow patients to try a new treatment before it is available to the general public. In some cases, this may be a new drug that has not been used in humans before, or it may be a drug or drug combination that is not currently used for that specific type of cancer. Early phase clinical trials are often used to test side effects of a drug or drug combination, while later phase clinical trials are used to see how effective a new treatment might be for a certain type of cancer. Clinical trials allow doctors and researchers to improve the treatment of cancers with possibly more effective therapies. A clinical trial may be a new, groundbreaking drug or it may have no effect. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation.

New types of treatment are being tested in clinical trials:

• Targeted therapy is the use of a drug that attacks specifically tumor cells and spares normal cells. These drugs often target the blood supply leading to reduction in cancer cell growth. These drugs are often given as oral medications to be taken on a daily basis while the tumor growth is controlled.
• Immunotherapy is a new cancer treatment that stimulates the body's immune system to attack cancer cells. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or biologic therapy. The merging data from the published clinical trial found relatively low rates of response to immunotherapy drugs. However, patients who respond to immunotherapy often enjoy a long duration of benefit. In addition, the probability of having severe side effects while using immunotherapy is likely to be much lower than traditional chemotherapy.