An overview of adrenal metastasis

Overview

Adrenal metastasis refers to cancer that originates in another area of the body and has spread to the adrenal glands. The adrenal glands are one of the most common areas of the body for cancer to spread to.

The adrenal glands are two small glands that sit above each of the kidneys. The adrenal glands produce hormones, including adrenaline and norepinephrine, which help to control important bodily functions such as heart rate and blood pressure.

Adrenal metastasis may be unilateral, affecting one of the adrenal glands, or bilateral if it occurs in both adrenal glands.

Symptoms

In most cases, people with adrenal metastasis do not have any symptoms. A person may experience pain around the site of the tumor, such as pain in the back or abdomen.

If adrenal metastasis occurs in both adrenal glands and affects more than 90% of the glands, a person may experience adrenal insufficiency. Symptoms can include:

• significant weight loss
• nausea
• fatigue and weakness
• abdominal pain
• lethargy
• fever
• confusion
• electrolyte imbalances

People may have general symptoms of metastatic cancer, such as:

• extreme tiredness or fatigue, which makes it difficult to carry out everyday activities
• pain
• shortness of breath or difficulty breathing
• unintentional weight loss

Causes and risk factors

Cancer in another area of the body may spread to the adrenal glands and cause adrenal metastasis.

Cancers that can spread to the adrenal glands include ones that begin in the:

• lungs
• breast
• gastrointestinal tract
• pancreas
• kidney

Certain types of cancers may increase the risk of adrenal metastasis.

A 2020 study including 579 people with adrenal metastasis found that the most common cancers to spread to the adrenal glands were lung, genitourinary, and gastrointestinal cancers.

Diagnosis

Doctors may discover adrenal metastasis through diagnostic testing for the underlying cancer. They find around 30–70% of adrenal metastasis incidentally.

Medical tests can identify adrenal metastasis. These may include:

• imaging scans, such as MRI, CT, or PET scans, to help identify if a tumor is benign or cancerous
• biopsy, in which doctors use a fine needle to take a sample from the adrenal glands for laboratory testing to check for cancer cells
• blood tests to check cortisol and adrenocorticotropic hormone (ACTH) levels, which can indicate how the adrenal glands are functioning

Treatment

Treating the primary cancer that has led to adrenal metastasis can be the most effective way of treating adrenal metastasis. This may include chemotherapy or radiation therapy.

If doctors can remove adrenal metastasis with surgery, a person may have an adrenalectomy. This is a surgical procedure to remove the cancerous adrenal gland.

Doctors may use laparoscopic surgery, which is minimally invasive and can cause fewer problems than open surgery. This may be suitable for adrenal tumors smaller than 6 centimeters (cm) that have not spread to surrounding areas.

During laparoscopic surgery, a surgeon will make small incisions into the abdomen or back. They use a thin tube — a laparoscope — to insert instruments into the body and remove the cancerous adrenal gland.

For larger tumors, a person may require open surgery to remove the tumor and any surrounding cancer in one piece to prevent the risk of the tumor breaking up and spreading the cancer.

Other possible treatments for adrenal metastasis include using radiation, heat, or extreme cold to destroy a tumor.

Outlook

According to a 2022 study, surgery to remove adrenal metastasis is a safe treatment option and may lead to long-term survival. Open surgery, a large tumor, and metastasis outside of the adrenal glands may have a less favorable outlook.

If people have adrenalectomy, factors that suggest a good outlook include the cancer having not spread to surrounding structures outside of the adrenal glands. Another factor is a disease-free period of more than six months after the initial diagnosis of the primary cancer.

The outlook for adrenal metastasis may depend on the type of primary cancer and treatment response.

According to a 2020 study, factors that increase the risk of mortality include:

• older age
• adrenal metastasis that has spread from the lungs
• metastasis in both adrenal glands, rather than one
• not having surgery to remove the cancerous adrenal gland

When to contact a doctor

Adrenal metastasis may not cause any symptoms, but if people have cancer or a history of cancer and experience any back or abdominal pain, they should talk with a doctor. These symptoms can also occur for other reasons.

A person will also need to contact a doctor if they have any symptoms of adrenal insufficiency, such as:

• fatigue
• nausea
• weight loss
• fever
• confusion

People will also need to contact a doctor if they have any general symptoms that may suggest a primary cancer has spread, such as:

• extreme tiredness or fatigue
• unexplained weight loss
• pain
• breathing difficulties or shortness of breath

Frequently asked questions

This section answers some frequently asked questions about adrenal metastasis.

What is the survival rate for metastatic adrenal cancer?

In a 2022 study of 435 people undergoing surgery to remove adrenal metastasis in 2000–2018, around one-third of them had long-term, 5-year survival following the procedure.

The size of the tumor, type of primary cancer, and whether cancer has spread to other sites may affect survival rates, as well as other factors such as age and overall health.

Is adrenal metastasis curable?

According to the 2022 study, adrenal metastasis may be curable if doctors can remove the entire adrenal tumor with clear margins, which also removes any cancer cells in surrounding tissues. Another factor is doctors removing the primary tumor with surgery or a person having successful treatment to cure the primary cancer.

How long do adrenal cancer patients live?

When discussing cancer outlook, doctors may refer to the 5-year relative survival rate (RSR) for a particular cancer type. This is the percentage of people who were living 5 years after diagnosis.

According to the American Cancer Society, the 5-year relative survival rates for people with a diagnosis of adrenal cancer are as follows:

• Localized: 73%
• Regional: 53%
• Distant: 38%
• All stages combined: 50%

Summary

Adrenal metastasis is the spread of cancer from another area of the body to the adrenal glands.

Cancer that begins in the lungs, breast, gastrointestinal tract, or kidneys may spread to the adrenal glands and other parts of the body.

Treatment for adrenal metastasis can include radiotherapy, chemotherapy, or surgery to treat the primary cancer, and surgery or other cancer treatments to remove the adrenal metastasis.

Successful treatment of the primary cancer and complete removal of the adrenal tumor may potentially cure adrenal metastasis.