Malignant (cancerous) tumors that arise in the adrenal cortex of the adrenal gland are called adrenal cortical carcinoma. These tumors are not common — only 5 to 10 percent of all adrenal tumors are malignant. However, they often behave aggressively and can produce excess hormones, causing a wide variety of symptoms. Large adrenal cortical tumors are difficult to cure with surgery alone. Patients with adrenal carcinomas often require a multidisciplinary treatment approach.
Adrenal cortical carcinomas can produce a variety of hormones that cause body changes such as weight gain, fluid retention, excess hair growth, and skin changes. Additional symptoms such as abdominal pain, a feeling of fullness, and weight loss may be caused by the tumor pressing on other organs.
An endocrinologist, surgeon, or other specialist may perform a variety of laboratory tests to determine whether the patient has excess hormones in the blood, urine, or saliva. If a functional tumor is diagnosed, imaging tests such as CT, MRI, or a whole-body PET scan may be performed to identify its location. In addition, a surgical biopsy may be necessary to confirm the diagnosis.
Treatment of adrenocortical carcinoma may include surgery, medications, radiation therapy, or chemotherapy, alone or in combination, depending on whether the cancer has spread (metastasized) beyond the adrenal glands. Patients with metastatic or recurrent tumors may be candidates for tumor ablation, which uses heat or cold to kill cancer cells. This technique, performed by an interventional radiologist, can relieve symptoms and improve quality of life for patients who are too sick to undergo surgery.