Treatments for cancerous pheochromocytoma

The following are treatment options for cancerous pheochromocytomas. The treatments depend on whether the cancer can be completely removed with surgery (is resectable) or can’t be completely removed with surgery (is unresectable). Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Doctors often describe cancerous pheochromocytomas using the words local, regional and metastatic. Local means that the tumour is only in the adrenal gland and has not spread to other parts of the body. Regional means close to or around the adrenal gland. Metastatic means the tumour has spread to a part of the body farther from the adrenal gland.

Supportive drugs called alpha blockers and beta blockers are an important part of treatment for pheochromocytomas. They are used to control high blood pressure and irregular heart rhythms caused by too much production of catecholamines by the tumour. These drugs are usually given 1 to 2 weeks before surgery. Blood pressure and heart rhythms must return to normal before surgery can be done.

Other supportive drugs may also be given to replace adrenal gland hormones after surgery. They are given until hormone levels return to normal. Hormone levels usually return to normal within 2 weeks after surgery if the cancer was completely removed.

Surgery is usually used to treat pheochromocytomas. Non-cancerous pheochromocytomas can usually be completely removed with surgery. The type of surgery done for cancerous pheochromocytomas depends on the spread of the tumour.

Adrenalectomy is a surgery to remove the adrenal gland.It is done if the cancer is only in the adrenal gland.

Debulking means removing as much of the cancer as possible. It may be used if the tumour has spread into nearby tissues. If there is spread to distant tissues (metastasis) or the tumour has come back (recurred) after treatment, then debulking may also be used.

Surgery for metastasis may be used to remove metastasis in the liver or the lungs.

After surgery, hormone replacement therapy may be needed until hormone levels return to normal. If both adrenal glands are removed, then steroid replacement is given for the rest of a person’s life.

Radiation therapy may be offered to treat metastatic and recurrent cancerous pheochromocytomas. The types of radiation therapy are:

• external beam radiation therapy to treat bone metastases
• targeted radiation therapy with radioactive metaiodobenzylguanidine (MIBG)

Chemotherapy may be offered to treat metastatic and recurrent cancerous pheochromocytomas. The most common combination of chemotherapy drugs used is CVD – cyclophosphamide (Procytox), vincristine (Oncovin) and dacarbazine (DTIC).

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

A few clinical trials in Canada are open to people with cancerous pheochromocytoma. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.