General Information
Adrenocortical carcinoma is a rare tumor that affects only 1 to 2 persons per
one million population. It usually occurs in adults, and the median age at
diagnosis is 44 years. Although adrenal carcinoma is potentially curable at early stages, only 30%
of these malignancies are confined to the adrenal gland at the time of
diagnosis.[1]
Radical
surgical excision is the treatment of choice for patients with localized malignancies and
remains the only method by which long-term disease-free survival may be
achieved. Overall 5-year survival for tumors resected for cure is
approximately 40%.
Retrospective studies have identified two important
prognostic factors: completeness of resection and stage of disease. Patients
without evidence of invasion into local tissues or spread to lymph nodes have
an improved prognosis.[2] The role of DNA ploidy as a prognostic indicator is
controversial, with some [3] studies, such as ECOG-1879, for example, showing correlation between aneuploidy and
prognosis, and other studies [2,4] showing no correlation.
Approximately 60% of patients present with symptoms related to excessive
hormone secretion, but hormone testing reveals that 60% to 80% of tumors are
functioning.[5,6] Nonfunctioning carcinomas may be heralded by symptoms of
local invasion by tumor or by metastases. Initial evaluation should include,
in addition to appropriate endocrine studies, computed tomography and/or
magnetic resonance imaging of the abdomen. Selective angiography and adrenal
venography may be helpful in identifying smaller lesions and for distinguishing tumors of
the adrenal gland from tumors of the upper pole of the kidney. Although the use of positron emission tomography may be effective in identifying unsuspected sites of metastases, its role as a staging tool is unclear.[7] The detection
of metastatic lesions may allow effective palliation of both functioning and
nonfunctioning lesions.
The most common sites of metastases are the peritoneum, lung, liver, and bone.
Palliation of metastatic functioning tumors may be achieved by resection of
both the primary tumor and metastatic lesions. Unresectable or widely
disseminated tumors may be palliated by antihormonal therapy with mitotane,
systemic chemotherapy, or (for localized lesions) radiation therapy. However,
survival for patients with stage IV tumors is usually less than 9 months unless
a complete remission is achieved.[6,8-10] There is no convincing
evidence to date that systemic therapy will improve the survival duration of patients
with adrenal cancer.
References
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Norton JA: Adrenal tumors. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds.: Cancer: Principles and Practice of Oncology. 7th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2005, pp 1528-39.
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Lee JE, Berger DH, el-Naggar AK, et al.: Surgical management, DNA content, and patient survival in adrenal cortical carcinoma. Surgery 118 (6): 1090-8, 1995.
[PUBMED Abstract]
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Camuto P, Schinella R, Gilchrist K, et al.: Adrenal cortical carcinoma: flow cytometric study of 22 cases, an ECOG study. Urology 37 (4): 380-4, 1991.
[PUBMED Abstract]
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Haak HR, Cornelisse CJ, Hermans J, et al.: Nuclear DNA content and morphological characteristics in the prognosis of adrenocortical carcinoma. Br J Cancer 68 (1): 151-5, 1993.
[PUBMED Abstract]
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Icard P, Chapuis Y, Andreassian B, et al.: Adrenocortical carcinoma in surgically treated patients: a retrospective study on 156 cases by the French Association of Endocrine Surgery. Surgery 112 (6): 972-9; discussion 979-80, 1992.
[PUBMED Abstract]
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Luton JP, Cerdas S, Billaud L, et al.: Clinical features of adrenocortical carcinoma, prognostic factors, and the effect of mitotane therapy. N Engl J Med 322 (17): 1195-201, 1990.
[PUBMED Abstract]
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Becherer A, Vierhapper H, Pötzi C, et al.: FDG-PET in adrenocortical carcinoma. Cancer Biother Radiopharm 16 (4): 289-95, 2001.
[PUBMED Abstract]
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Brennan MF: Adrenocortical carcinoma. CA Cancer J Clin 37 (6): 348-65, 1987 Nov-Dec.
[PUBMED Abstract]
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Cohn K, Gottesman L, Brennan M: Adrenocortical carcinoma. Surgery 100 (6): 1170-7, 1986.
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Wooten MD, King DK: Adrenal cortical carcinoma. Epidemiology and treatment with mitotane and a review of the literature. Cancer 72 (11): 3145-55, 1993.
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