Surgical Procedures: Surgery and Staging for Adrenal Cancer

When there are cancer cells in the adrenal glands, it is called adrenal cancer. There is one adrenal gland that sits on top of each of your 2 kidneys. These glands make hormones that help your body work. The adrenal glands are made up of two parts, the medulla and the cortex.

There are a few kinds of adrenal cancer:

• Adrenal adenoma is not cancer and does not need treatment unless it is causing problems like high blood pressure.
• Adrenal cortical carcinoma is found in the cortex and can cause symptoms if too much of any hormone is being made. It can cause weight gain, pain, fluid retention (holding onto fluid), extra hair on the face in women, and feeling full. Tumors that make too much steroid hormone are called functioning and the tumors that don’t are called non-functioning.
• Pheochromocytoma (adults)/neuroblastoma (kids) are cancers in the medulla.

Some people are at higher risk of adrenal cancer. Risk factors can be:

• High-fat diet.
• Smoking.
• Not enough exercise.
• Genetic Syndromes: Li Fraumeni syndrome, Beckwith-Wiedmann syndrome, multiple endocrine neoplasia, hereditary nonpolyposis colorectal cancer, and familial adenomatous polyposis.

What is staging and how is it done?

Staging is a way to find out if and where the cancer has spread in your body. Your provider will have you get a few tests to figure out the stage of your cancer. These tests may include:

Physical Exam: This is a general exam to look at your body and to talk about your past health issues.

Imaging: Radiology tests can look inside your body at the cancer and see if it has spread. These tests can include:

• Ultrasound.
• Chest X-ray.
• CT scan.
• Magnetic Resonance Imaging (MRI).
• Positron emission tomography (PET Scan).

Laboratory Tests: Blood and urine tests will be done to measure levels of hormones in your body, such as cortisol, aldosterone, androgen, and estrogen.

Procedures: Each case of adrenal cancer is different. Talk with your care team about which procedures may be part of your treatment plan. These options may be:

• Biopsy: Tissue is removed and looked at under a microscope to check for cancer cells.
• Laparoscopy: Small incisions (cuts) are made into your abdomen (belly). The surgeon will use surgical tools to look for cancer that has spread and any enlarged lymph nodes. Laparoscopy can be used first to see if the whole tumor can be removed with another surgery. Some small adrenal tumors can be removed with laparoscopy.

Adrenal cancer spreads to other parts of the body through the tissue, lymph, and blood systems. Cancer stage tells if and how far the cancer has spread, and what treatment options are best. Adrenal cancer is staged as stages I (one) through stage IV (four).

Stage I adrenal cancer is only in the adrenal gland. In stages II (two) and III (three), the tumor is larger, is either only in the adrenal gland, or has spread to the fat connected to the gland or nearby organs. It may have spread to nearby lymph nodes. In stage IV adrenal cancer, the cancer has spread to organs further away (like the lungs) and may be in the lymph nodes.

Read more about the staging of adrenal cancer in our article, “Adrenal Cancer: Staging and Treatment.”

Surgery is often used to treat adrenal cancer.

Surgical Procedures for Adrenal Cancer

The most common treatment for adrenal cancer is an “adrenalectomy.” This surgery removes one or both of your adrenal glands. Smaller tumors may be able to be removed through an incision made in your back, below your rib cage. Most adrenal tumors are removed through an incision made in your abdomen (belly) so that your surgeon can see more of the area. If the cancer has grown or spread to muscle, fat, or other organs, those will be removed also if possible.

What are the risks of adrenal cancer surgery?

As with any surgery, there are risks and possible side effects. These can be:

• Reaction to anesthesia (Anesthesia is the medication you are given to help you sleep through the surgery, to not remember it, and to help with pain. Reactions can include wheezing, rash, swelling, and low blood pressure).
• Infection.
• Bleeding.
• Blood clots (deep vein thrombosis and/or pulmonary embolism).
• Intestinal Ileus (when your bowel doesn’t work as it should).
• Your adrenal glands not being able to make enough hormones (adrenal insufficiency).
• Injury to nearby organs and/or blood vessels.

Before surgery, your care team will talk to you about any other risks based on your health and the surgery you are having.

What is recovery like?

Recovery from adrenal cancer surgery depends on the type of surgery you have had. A hospital stay of 3 to 5 days is often needed.

You will be told how to care for your surgical incisions and will be given any other instructions before leaving the hospital.

Your care team will talk with you about the medications you will be taking, such as those for pain, blood clot, infection, and constipation prevention, and any other medications you may need. If you had both adrenal glands removed, you will most likely have to take hormone replacement medication. Your provider will tell you what you need to take and how often.

Some common changes to your activity level after an adrenalectomy are to:

• Not lift anything over 5-10 pounds for 6 weeks.
• Stay away from rigorous activity for 4 weeks.
• Not drive while on narcotic pain medications or if you are unable to do your own daily activities.
• Wait to shower until 2 days after your surgery.
• Not bathe in a tub, swim, or put the incision under water for 1 to 2 weeks.

Call your care team if you have:

• Fever or chills. Your care team will tell you at what temperature you should call.
• Signs of a wound infection, such as redness, warmth, or drainage.
• Nausea, vomiting, and/or chills.
• Dizziness or lightheadedness.
• Shortness of breath.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that you can go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.