Treatment for adrenal cortical cancer

The main treatment for adrenal cortical cancer (ACC) is surgery. This gives the best chance of curing ACC. Unfortunately, ACC sometimes comes back after surgery or spreads to other parts of the body. Doctors call this advanced ACC. Treatment for advanced ACC is usually chemotherapy.

Deciding which treatment you need

A team of doctors and other professionals who specialise in ACC discuss the best treatment and care for you. They are called a multidisciplinary team (MDT). You might go to a different hospital if there isn’t a specialist MDT at your local hospital.

Your treatment depends on several factors. These include:

• how big the cancer is
• whether it has spread
• your general health and fitness

To decide what treatment you need, your team looks at your tests and scans to see if they can completely remove the cancer or not.

Generally, you have an operation to completely remove the cancer if you have an early stage ACC. This means that the cancer hasn’t spread to other parts of the body such as the liver or lungs.

You usually have chemotherapy if you have ACC that has come back after surgery or has spread to other parts of the body.

Surgery to completely remove ACC

Surgery gives the best chance of curing ACC. You usually have an operation called adrenalectomy. Your surgeon removes the whole of the affected adrenal gland. They might also remove:

• nearby lymph nodes
• part of nearby organs such as the liver, bowel, pancreas, and stomach

Chemotherapy after surgery

You might have a chemotherapy drug called mitotane (Lysodren) after surgery. This helps to lower the chance of the cancer coming back. 

Mitotane are tablets that you take 2 or 3 times a day. You might take them for at least 2 years after surgery.

Mitotane can have side effects. Your doctor and specialist nurse monitor you. You have blood tests regularly to check you are taking the right dose.

Possible problems during and after surgery to remove ACC

Hormones produced by the cancer can make your blood pressure unstable so it can change suddenly. This can happen during and immediately after surgery.

You usually have a drug called hydrocortisone during surgery and afterwards to lower the risk of complications.

You may need to take hydrocortisone for some time after surgery. Hydrocortisone is a man made version of cortisol. Your doctor checks your hormone levels regularly to make sure you have all the hormones you need.

Treatment for ACC that has come back or spread to other parts of the body (advanced ACC)

You usually have chemotherapy for advanced ACC. Your doctor might also suggest:

• an operation to remove as much of the cancer as possible (debulking surgery)
• other treatments such as radiotherapy and radiofrequency ablation (RFA)

These treatments won’t cure ACC. But they can help to control the growth of the cancer and relieve your symptoms.

Chemotherapy

You take the chemotherapy drug mitotane for ACC that has come back or spread to other parts of the body.

You may also have a combination of 2 or more chemotherapy drugs. Common chemotherapy treatments include:

• doxorubicin, etoposide and cisplatin
• gemcitabine and capecitabine
• streptozocin

Check the name of the chemotherapy treatment with your doctor or nurse, then find out about it on our A to Z list of cancer drugs.

Surgery to remove as much of the cancer as possible

This is called debulking surgery. Doctors aim to remove as much of the cancer as possible, rather than removing the cancer completely. You might have it if you have advanced ACC that makes a lot of hormones and is causing symptoms. Debulking surgery isn’t a common treatment for ACC.

Other treatments

Your doctor may suggest you have other treatments. You might have them on their own or in combination with mitotane.

Radiotherapy

Radiotherapy uses radiation, usually x-rays, to kill cancer cells. You usually have external radiotherapy. This means using a machine outside the body to direct radiation beams at the cancer to destroy it.

Radiotherapy can be useful for treating symptoms of cancer that has spread to the bones.

Treatment using heat to destroy ACC

This includes:

• radiofrequency ablation (RFA)
• microwave ablation (MWA)

RFA uses an electric current to heat tumour cells in the adrenal glands and destroy them. You usually have RFA using one or more probes (electrodes) that go through the skin, into the cancer. Once in place an electrical current passes from the probes to heat the cancer cells. This destroys them.

You have MWA in a similar way to RFA, but it uses a different type of energy to destroy cancer cells.

Cryotherapy

This uses extreme cold to destroy cancer cells. It is also called cryoablation. You usually have a small probe put next to or inside the tumour. This is called a cryoprobe.

Research into ACC

Researchers and doctors in the UK and around the world are trying to improve treatments for ACC. But because this type of cancer is so rare, it makes it difficult to carry out trials.

Coping

Coping with a diagnosis of a rare cancer can be especially difficult. Being well informed about your cancer and its treatment can help. It can make it easier to make decisions and cope with what happens.

Talking to other people who have the same thing can also help.

Our discussion forum Cancer Chat is a place for anyone affected by cancer. You can share experiences, stories and information with other people.

You can call our nurse freephone helpline on 0808 800 4040. They are available from Monday to Friday, 9am to 5pm. Or you can send them a question online.

The Rare Cancer Alliance offer support and information to people with rare cancers. It has a forum where you might be able to meet others with the same cancer as you.