Surgery is the primary treatment for adrenal gland cancer. Surgery is used to:
- potentially cure the cancer by completely removing the tumour
- remove as much of the tumour as possible (debulk), including metastases, to relieve the symptoms caused by:
- overproduction of hormones from functioning tumours
- growth of non-functioning tumours
The type of surgery done depends mainly on the type, size and extent of the tumour. Side effects of surgery depend on the type of surgical procedure.
Treatment may be needed before surgery to relieve specific symptoms caused by excessive amounts of hormones. This is particularly important in people who have pheochromocytoma because surgery may cause serious, life-threatening problems if the hormone levels are not well controlled. Treatment is usually given for 2–3 weeks before surgery.
- Medications may be given to:
- reduce the amount of hormones in the blood
- regulate blood pressure
- correct irregular heart rhythms
- correct the amount of fluid and potassium in the body
- People may be encouraged to take in salt and fluid to help reduce severe drops in blood pressure when standing up from a seated or lying position.
Drugs may need to be continued for some time after surgery. Hormone levels usually return to normal in approximately 2 weeks after surgery.
Adrenalectomy is the surgical removal of the adrenal gland. It is the primary treatment for all stages of adrenal gland cancer.
- Adrenalectomy is done through an incision in the abdomen or the lower back above the hip (flank) while the person is under general anesthetic.
- If the tumour has grown into the kidney, all or part of that kidney is also removed.
- If the tumour has grown into fat or muscle around the adrenal gland, the doctor will remove these tissues as well.
- The stay in hospital following adrenalectomy may be 5–7 days.
During a laparoscopic adrenalectomy, the surgeon uses a laparoscope (a flexible tube containing instruments) to remove the adrenal gland. The scope is placed through a small incision in the abdomen or the back. Laparoscopic adrenalectomy:
- may be used for small tumours about 6 cm or smaller in size that are believed to be benign (imaging shows no evidence of spread to nearby tissues or metastases)
- is usually not used for tumours larger than 5 or 6 cm because:
- There is a greater possibility that these are tumours are malignant.
- There is a higher risk that the tumour will rupture and the tumour cells will spread with this procedure.
- may be attempted for larger tumours when imaging shows no evidence of local invasion
- the surgeon may need to switch to open surgery if there is either evidence of malignancy or technical difficulty removing large tumours
The stay in hospital following laparoscopic adrenalectomy is usually 2–3 days.
Surgical debulking for advanced adrenal gland cancer is done to remove as much of the tumour as possible. Removal of metastases from the liver and lung may also be done. Removing as much of the tumour as possible will reduce the amount of hormones that are overproduced by the tumour and relieve the symptoms caused by the high hormone levels.
See a list of questions to ask your doctor about surgery.