Adrenal carcinoma is a rare and aggressive form of cancer that originates in the adrenal glands, which sit atop each kidney and produce vital hormones for the body. While the term "adrenal carcinoma" might evoke concern, it’s important to note that the vast majority of adrenal tumors are not cancerous. For many patients, the discovery of an adrenal tumor, often incidentally during imaging for unrelated issues, does not lead to a cancer diagnosis. However, surgery may be necessary for a small percentage of patients, particularly those with atypical imaging phenotypes, to ensure the best outcomes.

At the Carling Adrenal Center, we specialize in diagnosing and treating adrenal tumors, including adrenal carcinoma. During Adrenal Cancer Awareness Month this January, we aim to educate patients about adrenal carcinoma and provide clarity on when surgery is needed for adrenal tumors.

Adrenal Carcinoma: Understanding These Rare Adrenal Tumors

What is Adrenal Carcinoma?

Adrenal carcinoma is a rare type of cancer that arises in the adrenal cortex, the outer layer of the adrenal gland responsible for producing hormones such as cortisol, aldosterone, and androgens. This condition is rare, with an estimated incidence of one to two cases per million people annually. Because adrenal carcinoma is aggressive, early detection and treatment are crucial to improving outcomes.

Despite the severity of adrenal carcinoma, it’s essential to remember that most adrenal tumors are benign. Non-cancerous adrenal tumors, often called adrenal adenomas, are common and frequently discovered incidentally during imaging studies performed for unrelated reasons.

Adrenal Tumors: Most Are NOT Adrenal Carcinoma

Adrenal tumors are found in about 1 in 10 people who undergo abdominal imaging, such as a CT or MRI scan, but the vast majority are benign. These tumors are often referred to as "adrenal incidentalomas" because they are typically discovered accidentally. Benign adrenal tumors usually do not produce hormones and do not require treatment, other than occasional monitoring.

Figure 1. CT scan showing liver metastasis (arrows) from left adrenal cancer. This cancer overproduced estrogen in a man, and the first symptoms were enlargement of the breasts (gynecomastia).

However, adrenal carcinoma is different. This rare cancer often presents with symptoms or imaging findings that raise concern. Understanding these distinctions is critical for identifying which patients may need further evaluation or surgery.

Recognizing Symptoms of Adrenal Carcinoma

Symptoms of adrenal carcinoma can vary widely depending on whether the tumor produces hormones. Hormone-producing adrenal carcinomas, or functional tumors, can cause symptoms such as:

1. Unexplained Weight Gain or Loss: Rapid changes in weight may indicate hormonal imbalances caused by adrenal carcinoma.
2. High Blood Pressure: Excess production of aldosterone or cortisol can lead to hypertension that is difficult to control with medications.
3. Hormonal Changes: Symptoms such as excessive hair growth, irregular menstrual cycles, or feminization in men or virilization in women may be linked to hormone-secreting adrenal carcinoma.
4. Abdominal Pain or Fullness: Larger tumors may cause discomfort or a sensation of fullness in the abdomen.
5. Muscle Weakness: Hormonal imbalances, particularly excess cortisol, can lead to muscle weakness and fatigue.
6. Unexplained Anxiety or Depression: Hormonal changes caused by adrenal carcinoma can also affect mood and emotional health.

If you experience any of these symptoms, it’s important to consult a specialist for evaluation.

How Adrenal Carcinoma is Diagnosed

Diagnosing adrenal carcinoma requires a combination of biochemical testing and imaging studies. At the Carling Adrenal Center, our approach to diagnosing adrenal carcinoma includes:

1. Blood and Urine Tests: These tests help determine if the tumor is producing excess hormones, which can provide clues about whether it is cancerous.
2. Imaging Studies: Advanced imaging techniques, such as CT and MRI scans, are used to evaluate the size, shape, and characteristics of the adrenal tumor. Tumors with atypical imaging phenotypes—such as irregular borders, high density, or rapid growth—are more likely to be cancerous.

Figure 2. A CT scan showing an adrenal cancer from the right side, which was possible to treat with complete surgical removal. This patient was completely asymptomatic and the only reason for suspecting cancer was the atypical imaging phenotype (irregular borders, and high density) identified on CT scan.

The Role of Atypical Imaging Phenotypes in Determining Surgery

At the Carling Adrenal Center, approximately 16% of patients with adrenal tumors present with atypical imaging phenotypes. These characteristics include irregular or spiculated tumor edges, a high likelihood of vascular invasion, or rapid tumor growth. For these patients, surgery is often recommended to remove the tumor and prevent potential complications.

Surgery is particularly important in cases where adrenal carcinoma cannot be definitively ruled out based on imaging alone. Early surgical intervention can improve outcomes by removing the tumor before it has the chance to spread to other parts of the body.

Surgery for Adrenal Carcinoma: Why Expertise Matters

Surgery is the cornerstone of treatment for adrenal carcinoma, and the experience of the surgeon plays a critical role in achieving the best outcomes. At the Carling Adrenal Center, Dr. Tobias Carling is widely considered the best adrenal surgeon, and is one of the world’s most experienced adrenal surgeons, having performed thousands of adrenal operations with excellent outcomes. His expertise in minimally invasive adrenalectomy ensures that patients receive the highest level of care with reduced recovery times and lower complication rates.

Patients with adrenal carcinoma require precise surgical techniques to remove the tumor completely without causing tumor spillage and recurrence. Choosing a high-volume adrenal surgery center like the Carling Adrenal Center is essential for optimal results.

Figure 3 shows the large, 13 cm left adrenal mass after it was removed by Dr. Carling. The pathology revealed adrenal cancer with negative margins (meaning all cancer was removed).

Why Adrenal Carcinoma Awareness is Important

Adrenal carcinoma is rare, but awareness is critical for ensuring that patients with suspicious adrenal tumors receive timely and accurate diagnoses. By understanding the signs and symptoms of adrenal carcinoma, patients can seek evaluation early and avoid delays in treatment.

Adrenal Cancer Awareness Month in January serves as an opportunity to educate the public about adrenal tumors and the importance of specialized care. The Carling Adrenal Center is committed to raising awareness and providing expert care to patients with adrenal carcinoma and other adrenal conditions.

Additional Resources: 

• Learn more about the Carling Adrenal Center
• Learn more about Dr. Tobias Carling
• Learn more about our sister surgeons at the Norman Parathyroid Center, and Clayman Thyroid Center.
• Learn more about the Hospital for Endocrine Surgery