Treatment of Metastatic Disease to the Adrenal Gland
There are a number of strategies used to treat metastatic disease that has traveled to the adrenal gland. There are several principles that are followed when considering how to treat these types of tumor:
Treat the underlying cancer
First and most important is to treat the primary tumor (where the tumor originates from). For many patients, this has or will involve surgery as well as treatment with systemic therapy (chemotherapy, radiation, immune therapy). Systemic therapy uses medications 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 in pill form by mouth. Since metastasis to the adrenal gland is usually a sign of a more aggressive cancer that has a higher 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
When tumors that are not of adrenal origin begin to grow in the adrenal gland, the function of the adrenal gland can become compromised. Key hormones, such as cortisol and aldosterone may no longer be produced in sufficient amounts, and adrenal insufficiency may result. In general, abnormalities in sodium, potassium and fluid in the body may be altered to levels that can cause serious problems. If this becomes severe and goes unrecognized (Addisonian crisis), death may result. 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 sodium, potassium, cortisol 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 given intravenously.
Treat the adrenal metastasis
Specific treatment of an adrenal metastasis to include radiation therapy or surgery is sometimes recommended.
Radiation therapy is the use of x-rays or other high-energy particles in the form of a targeted beam to kill cancer cells and prevent tumors from growing. Radiation therapy has commonly been used to treat metastatic disease to the adrenal glands 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. Some tumors treated with radiation may experience regression or at least stability. In some, the tumor will not respond to radiation therapy and continue to grow.
Adrenalectomy is sometimes recommended for patients with metastasic disease that has traveled to one of the adrenal gland. Often, the operation can be done using minimally invasive techniques such as laparoscopic adrenalectomy. 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 metastases 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.