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What is adrenal cancer (adrenocortical carcinoma)?
Adrenal cancer, most often a type called adrenocortical carcinoma, is a rare cancer that begins in one of the two small adrenal glands — the triangle-shaped glands that sit on top of each kidney. These glands are tiny but powerful: they make hormones that control blood pressure, the body's salt and water balance, blood sugar, and the stress response. Most growths found in the adrenal gland are harmless (called adenomas), and adrenal cancer is uncommon. Some adrenal cancers are 'functioning,' meaning they pump out extra hormones that cause symptoms such as weight gain, high blood pressure, easy bruising, or changes in body hair and the menstrual cycle. Others are 'non-functioning' and are often found only when they grow large enough to press on nearby organs or are spotted by chance on a scan. Because the adrenal glands are deep in the back of the abdomen near the kidney, liver, and major blood vessels, treatment is carefully planned by a specialized team. Surgery is the foundation of cure, with medicine and radiation playing important supporting roles.
The main types
Doctors group adrenal cancer (adrenocortical carcinoma) by where it starts and how it behaves:
| Type | What it means, simply |
|---|---|
| Adrenocortical carcinoma | The main type of adrenal cancer — it starts in the outer layer (cortex) of the gland, where steroid hormones are made. |
| Functioning tumor | An adrenal cancer that makes extra hormones, causing symptoms like high blood pressure, weight gain, or hormone changes. |
| Non-functioning tumor | An adrenal cancer that does not make extra hormones and is often found because of its size or by chance on imaging. |
| Pheochromocytoma (related adrenal tumor) | A different, usually non-cancerous tumor of the gland's inner part (medulla) that can release adrenaline-like hormones — managed differently from adrenocortical carcinoma. |
Staging, in plain terms
Adrenal cancer is staged using the TNM system, which looks at the size of the Tumor and whether it has grown beyond the gland, whether nearby lymph Nodes are involved, and whether it has spread (Metastasized) to distant organs such as the lungs or liver. Doctors also test the blood and urine for the hormones the tumor may be making, because that affects both symptoms and treatment. Putting these together helps the team plan surgery and decide whether added treatment is needed.
| TNM (with hormone evaluation) | What it generally means |
|---|---|
| Stage 1 | A small tumor (about 2 inches or less) still confined to the adrenal gland — the most favorable situation, usually removed by surgery. |
| Stage 2 | A larger tumor still confined to the gland, without spread to lymph nodes or distant organs. |
| Stage 3 | The tumor has grown into nearby tissue, blood vessels, or local lymph nodes but has not spread to distant organs. |
| Stage 4 | The cancer has spread to distant organs such as the lungs, liver, or bone — treated with a combination of medicine, surgery when helpful, and radiation. |
The standard of care
Adrenal Cancer (Adrenocortical Carcinoma) is almost always treated by a team that may include a surgeon, a medical oncologist, and a radiation oncologist, combining therapies for the best result. The usual building blocks are:
Surgery
Removing the whole adrenal gland and tumor (adrenalectomy) by an experienced surgeon is the main chance for cure when the cancer is confined. Taking the tumor out intact, without rupturing it, gives the best results.
Mitotane (adrenal-specific medicine)
A pill that acts specifically on adrenal cortex cells. It is often used after surgery to lower the chance of return and to control tumors that can't be removed, sometimes for a long time.
Chemotherapy
For advanced disease, drug combinations (often with mitotane) can slow the cancer and shrink tumors that have spread.
Radiation therapy
Focused radiation is used to lower the chance of return after surgery in higher-risk cases and to control or relieve tumors that have spread, such as to bone or the area where the gland was removed.
How radiation treatment works
Radiation uses focused high-energy x-rays to damage the DNA inside tumor cells so they can no longer grow and divide. The adrenal gland sits in a crowded part of the body, close to the kidney, liver, bowel, and spine, so modern image-guided radiation is planned carefully to concentrate the dose on the tumor while protecting these sensitive neighbors. In adrenal cancer, radiation is most often used after surgery to lower the risk of return in the same area, or to control and relieve tumors that have spread. Treatments are painless and brief, given over a small number of sessions. Side effects depend on the area treated and are usually temporary, such as fatigue, mild nausea, or local skin irritation. Radiation works best here as a precise, supportive tool alongside surgery and medicine rather than as a stand-alone cure.
The main ways radiation is delivered for adrenal cancer (adrenocortical carcinoma):
Adjuvant (post-surgery) radiation
Targeted radiation to the tumor bed after surgery can reduce the chance of the cancer coming back in the same area, especially when margins were close or the tumor was high-risk.
Palliative radiation
Precise radiation aimed at painful or troublesome deposits — for example in bone — to relieve symptoms and improve comfort.
Stereotactic body radiation (SBRT)
Highly focused, high-dose radiation in a few sessions can control a limited number of metastatic spots while sparing nearby organs like the kidney, liver, and bowel.
Latest studies shaping care
Care keeps improving — often toward getting the same excellent results with less burden on patients. A few developments:
Mitotane after surgery lowers recurrence: Studies show that adrenal-specific medicine given after complete surgery can reduce the chance of the cancer returning in higher-risk patients, and it remains a cornerstone of care.[1]
ADIUVO trial and international ACC guidelines
Radiation to the tumor bed reduces local return: Adding focused radiation to the area where the tumor was removed has been shown to lower the chance of the cancer coming back in that spot for selected high-risk patients.[2]
Retrospective adjuvant radiotherapy series, ENSAT network
New systemic options under study: Researchers are testing targeted drugs and immunotherapy for advanced adrenal cancer, aiming to add options beyond chemotherapy and mitotane.[3]
Ongoing phase 2 trials, ESMO updates
Common questions
Are most adrenal tumors cancer? No. The great majority of growths found on the adrenal gland are benign (non-cancerous) adenomas, often discovered by chance on a scan. Adrenal cancer is rare, and your doctor uses imaging, hormone tests, and sometimes the tumor's size to tell them apart.
Why do I need hormone tests? Some adrenal cancers make extra hormones that cause symptoms like high blood pressure, weight gain, or easy bruising. Measuring these hormones helps your team understand the tumor, plan safe surgery, and follow your progress afterward.
Will I need radiation? Not everyone does. Surgery is the main treatment when the cancer is confined. Radiation is added in higher-risk cases to lower the chance of return, or to control and relieve tumors that have spread. Your team will tell you whether it fits your situation.
References
Numbered sources for the studies cited above. Links open the primary publication on PubMed or the publisher’s site.