How Is Adrenal Cancer Found?

It is hard to find adrenal cancer early. Often the tumor has grown quite large before it is found. It is often found earlier in children than in adults because children react more to the hormones these tumors make.

The symptoms of adrenal cancer can be caused by either the hormones they produce or because the tumor is pressing on nearby organs. If you or your child has any of the symptoms below, talk to your doctor right away. Getting the right tests is the only way to find out for sure what is causing the symptoms.

Signs and Symptoms of Adrenal Cancer

Symptoms caused by the hormones androgen or estrogen: In children, symptoms are most often caused by male-type hormones (androgens) that the tumor makes. These symptoms include:

• excess growth of facial, pubic, and underarm hair


• enlargement of the penis (boys)


• enlargement of the clitoris (girls)

A different set of symptoms can occur if the tumor makes female-type hormones (estrogens). These include:

• early puberty in girls (having periods and the breasts getting larger)


• breasts getting larger (boys)

In adults, the symptoms from sex hormones are harder to spot because these changes have already taken place. Women with tumors that make estrogen often do not have any symptoms unless the tumor is large enough to press on nearby organs. Men with tumors that make estrogen may have slight breast tenderness and enlargement. They may also notice less sex drive and trouble getting an erection.

Women with tumors that make androgens may notice the growth of excess facial and body hair, irregular periods, and deepening of their voice.

There is a group of symptoms called Cushing syndrome that results from high levels of a hormone called cortisol (or hormones like it). Some of the symptoms of Cushing syndrome include:

• weight gain, often around the chest and stomach


• fat deposits behind the neck and shoulders


• purple stretch marks on the stomach


• hair growth on the face, chest, and back in women


• irregular periods


• weakness in the legs


• easy bruising


• depression or moodiness


• broken bones from osteoporosis (thinning of the bones)

But there are several reasons for having high cortisol levels. Your doctor will need to do a number of tests to find out if the symptoms are from adrenal cancer or some other cause.

If the tumor makes a hormone called aldosterone, the main symptoms include:

• high blood pressure


• weakness


• muscle cramps


• increased thirst


• urinating very often

Most often, though, the aldosterone is made by an adenoma rather than by cancer.

If the tumor is large and presses on nearby organs and tissues it can cause pain, a feeling of fullness in the stomach, or trouble eating because the stomach feels full.

If you have any of the signs or symptoms above, talk to your doctor right away. Remember, the sooner your cancer is found, the sooner you can start treatment. And the earlier you get treatment, the more effective it will be.

If there is any reason to suspect cancer, the first step will be a complete medical history and physical exam. Your doctor will want to know if anyone in your family has had adrenal cancer. You?ll also be asked about your periods or other sexual issues and what symptoms you have had. One or more of the tests below may also be done.

Imaging Tests

Chest x-ray: This can tell if the cancer has spread to the lungs. It may also help to see if you have any lung or heart diseases.

Ultrasound: This test uses sound waves to make pictures of internal organs. The computer displays the picture on a screen. This test will be able to show if there is a tumor mass in the adrenal gland. It can also show if there is a tumor in the liver. Most likely it won?t be used unless a CT scan can?t be done.

CT scans (computed tomography): A CT scan uses x-rays to make detailed pictures of your body. Instead of taking just 1 x-ray, a CT scanner takes many pictures as it moves around you. A computer then combines these into a picture of a slice of your body. CT scans can show the adrenal glands and can often confirm whether a tumor is present, how large it is, and whether it has spread to nearby sites. CT scans also show the organs near the adrenal glands, as well as lymph nodes and distant organs. This test can help show if the cancer has spread to the liver or other organs. It also may be used to guide a needle into an area of concern. Once the needle is in, a piece of tissue is removed to be looked at under a microscope. This is called a CT-guided needle biopsy.

CT scans take longer than regular x-rays and you need to lie still on a table while they are being done. Also, you might feel a bit confined by the machine you lie in while the scan is being done. But CT scans are getting faster and your stay might be pleasantly short.

PET scan (positron emission tomography): For a PET scan, a type of radioactive sugar is injected into a vein. The sugar collects in cancer cells. A scanner can spot these deposits. This test is useful for finding cancer that has spread beyond the adrenal glands. It also helps to stage the cancer. Some doctors feel it can be useful in telling whether a tumor in the adrenal gland is cancer or not.

MRI (magnetic resonance imaging): MRI scans use radio waves and strong magnets instead of x-rays. MRI pictures look a lot like those of a CT scan, but MRIs are more detailed. An MRI scan can also show views from several angles. The MRI may sometimes provide more information than a CT scan because it can better show the difference between adrenal cancer and a benign tumor. An MRI is especially helpful in looking at the brain and spinal cord.

MRI scans can be a little more uncomfortable than CT scans because they take longer, often up to an hour. Also, you must lie still inside a tube, which may be upsetting to some people. The machine makes a thumping noise as the magnet switches on and off. Some places have earplugs or headphones with music to block this out.

Other Tests

Laparoscopy (lap-uh-ros-kuh-pee): The doctor may do this test in order to get ready for surgery. The laparoscope is a thin, flexible tube with a tiny video camera on the end. It is inserted through a small opening in the patient?s sideto look at the tumor. It can be used to make sure all the cancer can be removed.

Biopsy: In a biopsy a sample of tissue is removed to see whether cancer cells are present. This test may be done before surgery by using a needle that removes small pieces of tissue. A CT scan or ultrasound might be used to help guide the needle. The results can show whether the tumor started in the adrenal cortex, the medulla, or some other part of the body. But it might not show whether the tumor is cancer or not. For this reason, surgery is done if the tumor?s size and certain features suggest it is cancer. If it looks as if the cancer has spread to another part of the body such as the liver, then a biopsy may be done there, too.

Blood and urine tests: These tests are important in deciding whether a patient with symptoms of adrenal cancer has the disease. Doctors choose which tests to do based on the patient?s symptoms. Because they know which symptoms are linked with high levels of certain hormones, they can select the right test for the patient.