Diagnosis of adrenal gland cancer

Diagnosis is the process of finding out the cause of a health problem. Diagnosing adrenal gland cancer may begin with a visit to your family doctor. Your doctor will ask you about any symptoms you have and do a physical exam. But many times adrenal gland tumours are found by chance (incidentally).

Based on this information, your doctor may refer you to a specialist or order tests to check for adrenal gland cancer or other health problems.

The process of diagnosis may seem long and frustrating. It’s normal to worry, but try to remember that other health conditions can cause similar symptoms as adrenal gland cancer. It’s important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of adrenal gland cancer.

The following tests are usually used to rule out or diagnose adrenal gland cancer. Many of the same tests used to diagnose cancer are used to find out the stage (how far the cancer has progressed). Your doctor may also order other tests to check your general health and to help plan your treatment.

Your health history is a record of your symptoms, risk factors and all the medical events and problems you have had in the past. Your doctor will ask questions about your history of:

• symptoms that suggest adrenal gland cancer
• hereditary (inherited) conditions linked to an increased risk of adrenal gland cancer

Your doctor may also ask about a family history of adrenal gland and other cancers.

A physical exam allows your doctor to look for any signs of adrenal gland cancer. During a physical exam, your doctor may:

• check your blood pressure
• feel the abdomen for enlarged organs or a lump

Find out more about a physical exam.

Urine tests measure the levels of adrenal gland hormones and the products of their breakdown (metabolites) in the urine.

High cortisol levels may mean that there is an adrenal gland tumour. A 24-hour urinary metanephrine and normetanephrine level test may be done to measure the hormones called catecholamines produced by the adrenal medulla and to check for a pheochromocytoma.

Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are functioning and can help find abnormalities. Blood chemistry tests used to diagnose adrenal gland cancer look for the following.

• High levels of cortisol may mean there is an adrenal gland tumour making cortisol.
• High levels of aldosterone may mean there is an adrenal gland tumour making aldosterone.
• High levels of testosterone or dehydroepiandrosterone sulphate (DHEAS) may mean there is an adrenal gland tumour producing androgen.
• High levels of estrogen may mean there is an adrenal gland tumour producing estrogen.
• High levels of follicle-stimulating hormone (FSH) mean that there is probably not an adrenal gland tumour producing too much androgen or estrogen.
• Low levels of potassium and renin may mean there is an adrenal gland tumour producing too much aldosterone.
• Low levels of adrenocorticotropic hormone (ACTH) and a high level of cortisol may mean there is a functional adrenal gland tumour.
• High levels of epinephrine or norepinephrine may mean there is a pheochromocytoma.
• High levels of the protein chromogranin A in the adrenal medulla may mean there is a pheochromocytoma.

Find out more about blood chemistry tests.

A dexamethasone suppression test may be done to measure the cortisol level in the blood. A dose of dexamethasone is taken by mouth to slow the production of cortisol. The blood cortisol level is measured 12 hours later.

If there is no adrenal gland tumour, the level of cortisol in the blood will be lower than normal. If there is an adrenal gland tumour, the level of cortisol will be high or normal.

An ultrasound uses high-frequency sound waves to make images of parts of the body. It is not usually used to diagnose adrenal gland cancer but it may find an adrenal gland tumour when it is being done for other medical reasons.

Find out more about an ultrasound.

An x-ray uses small doses of radiation to make an image of parts of the body on film. A chest x-ray may be used to detect the spread of cancer to the lungs.

Find out more about an x-ray.

A computed tomography (CT) scan uses special x-ray equipment to make 3-D and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures.

A CT scan is used to:

• find a tumour in the adrenal gland
• find out if the tumour has spread and where it has spread
• help find out if a tumour is cancerous or non-cancerous based on its features, such as the size, the density and whether the edges are smooth or uneven

Find out more about a CT scan.

Magnetic resonance imaging (MRI) uses powerful magnetic forces and radiofrequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3-D pictures.

An MRI is used to:

• find out if the tumour has spread and where it has spread, and if there is a problem with the blood vessels
• help find out if a tumour is cancerous or non-cancerous based on its features, such as the size, the density and whether the edges are smooth or uneven

Find out more about an MRI.

A positron emission tomography (PET) scan uses radioactive materials called radiopharmaceuticals to look for changes in the metabolic activity of body tissues. A computer analyzes the radioactive patterns and makes 3-D colour images of the area being scanned.

A PET scan may be used to:

• help find out if a tumour is more likely to be cancerous or non-cancerous
• check for small groups of cancer cells
• find out if cancer has spread to other parts of the body

Find out more about a PET scan.

A metaiodobenzylguanidine (MIBG) scan is a nuclear medicine imaging test that uses small amounts of the radiopharmaceutical MIBG to help locate and diagnose certain types of cancer.

MIBG scans are used to find pheochromocytomas that develop in the inner layer of the adrenal gland (adrenal medulla). Tumours that develop in the outer layer of the adrenal gland (adrenal cortex) are not seen with this test.

Find out more about an MIBG scan.

A bone scan uses bone-seeking radioactive materials (called radiopharmaceuticals) and a computer to create a picture of the bones. It is used to find out if adrenal gland cancer has spread to the bones.

Find out more about a bone scan.

During a biopsy, the doctor removes tissues or cells from the body so they can be tested in a lab. A report from the pathologist will confirm whether or not cancer cells are found in the sample.

A biopsy is not usually done for adrenal gland tumours because it is hard to see a difference between non-cancerous and cancerous adrenal tumour cells under a microscope. Also, a biopsy of an adrenal gland can cause serious problems such as excessive blood loss (hemorrhage), a collapsed lung (pneumothorax) and sudden increases in hormone levels (catecholamines).

Generally, a biopsy is only done if cancer is found but it is not clear whether it started in the adrenal gland or spread to the adrenal gland from a different place (secondary adrenal gland cancer). The following types of biopsies might be done.

Core biopsy uses a hollow needle or probe to remove a piece of tissue so it can be examined under a microscope.

Fine needle aspiration (FNA) uses a very thin needle to remove a small amount of fluid or cells from a lump or mass.

Find out more about biopsy, fine needle aspiration (FNA) and core biopsy.

To make the decisions that are right for you, ask your healthcare team questions about a diagnosis.