Adrenal Cancer Diagnosis and Staging

Most adrenal cancers have grown for a long time before they are diagnosed. They are often found after the patient seeks treatment for the symptoms caused by the cancer. However, some tumors are found when a physician orders imaging testing for another condition.

Patients with symptoms suspicious for adrenal cancer will undergo tests to determine the cause of these symptoms. The first step is a thorough medical history and physical exam to determine the extent of symptoms and their possible causes.

Further evaluation may include the following:

Blood and urine tests will be done to evaluate levels of adrenal hormones. Remember that adenomas (benign tumors) may produce high levels of adrenal hormones. Therefore, high hormone levels do not always indicate an adrenal cancer. Some blood and urine tests may be done after you are given a steroid such as dexamethasone. The blood and urine tests after the medication will measure your bodies’ response to the steroid, indicating the presence of a hormone secreting tumor or other problem with the adrenal gland.
Computed Tomography (CT)
The CT scan can show small tumors as well as important blood vessels that the tumor might be growing into or around. A CT scan can look at surrounding organs for spread (metastasis) of the cancer into lymph nodes or other organs in the abdomen.

A CT scan takes longer than a regular x-ray. You will lie still on a table while it is being done. Usually, you will need an IV placed for a dye injection just before the scan. You may also be asked to drink a contrast solution before the exam. This helps outline the intestine so it is not mistaken for tumors.
Magnetic Resonance Imaging (MRI)
The MRI scan uses magnets to make a picture of the inside of the body. MRIs produce very sharp, precise pictures of the area and can be helpful in distinguishing an adenoma from a cancer.
Ultrasound of the abdomen:
An ultrasound can identify a tumor or mass by using sound waves to make a picture of the inside of the abdomen. This is the fastest and cheapest test used; however it is the least accurate. It can be difficult to tell the difference between an adenoma and cancer with an ultrasound. An ultrasound may be used to guide the biopsy procedure as described above under CT scan.
Positron emission tomography (PET)
A PET scan involves the injection of radioactive sugar into a vein followed by a body scan that looks for areas taking up the sugar. Cancer cells take up sugar much faster than normal tissue, so cancerous areas can be located with this test. Research studies have shown the usefulness of PET scanning in identifying adrenal tumors. However, studies are still in progress to look at ways PET scanning can be used to tell the difference between adrenal cancers and benign adenomas and between primary adrenal cancers from metastatic tumors that started in other organs. One of these studies uses a substance called metomidate as the radioactive substance. Some studies suggest it can be helpful in distinguishing primary tumors from metastatic ones.
Angiography
The adrenal gland is situated near a number of important veins and arteries. Some studies may be necessary to evaluate the involvement of these blood vessels, such as whether the tumor is compressing or blocking them. These studies are referred to as selective angiography and adrenal venography.

Staging Adrenal Cancer

In general, patients with adrenocortical cancer are divided into 4 groups or stages of adrenal cancer.

The 4 stages of adrenal cancer are:

Stage 1: The cancer is smaller than 5 centimeters (2 inches) and has NOT spread outside of the adrenal gland.

Stage 2: The cancer is larger than 5 centimeters and has NOT spread outside of the adrenal gland.

Stage 3: The cancer has spread into the fat surrounding the adrenal gland or has spread to the lymph nodes or other organs near the adrenal gland.

Stage 4: The cancer has spread to adjacent organs / other parts of the body.

Because adrenal cancer is so uncommon, there are several staging systems that may be used. This system of staging is the most recently developed and implemented by the World Health Organization (WHO).

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