Adrenal Cancer

Any patient who is suspected of having adrenal cancer should undergo a complete medical evaluation. Many tests may be necessary in order to know for sure. The most important steps to make a diagnosis of adrenal cancer are:

• Clinical history and physical exam. The doctor will obtain detailed information about symptoms and personal and family history. A thorough physical exam and blood and urine tests will be done.

• Urine and blood hormone tests. The adrenal gland makes different hormones, which travel in the blood before being passed out of the body with the urine. Blood tests and 24-hour urine sampling can be very helpful to see what kind of cancer is in the body, especially adrenal cancers.

• Activating and inhibitory blood tests. The hormone production of the adrenal glands is under strict regulation in the body. Injections of certain medications to increase or decrease hormones made by the adrenal glands will usually lead to more or less hormone being detected in the blood. Cancer, however, does not usually react to these stimuli.

Imaging tests

• Ultrasonography. This test uses sound waves to look for abnormalities. The sound waves bounce off body parts and send back an image, like sonar on a submarine. A computer then looks at the signals sent back by the sound waves and creates an image of the body using those signals. This test is very helpful in seeing if an adrenal tumor is a cyst, a fluid-filled sac that is probably not cancer, or a solid tumor, which is more likely to be cancer. Ultrasound can also estimate the size of the mass.

• Computed tomography (CT) scan. A CT scan uses X-rays. In this test, an X-ray beam moves around the body and takes pictures of the body from many angles. These different pictures are then combined by a computer, giving the doctor a very detailed cross-section of the body. CTs can measure size well and can suggest the density of the mass, which may help in telling the difference between a benign mass and cancer. 

• Magnetic resonance image (MRI). An MRI uses magnets and radio waves to take pictures of the inside of the body. It yields detailed pictures, a lot like a CT scan, without the use of X-rays. MRIs can be useful because they show more detail than other types of imaging tests.

• Nuclear imaging tests. For these tests, slightly radioactive substances are injected into the body. Depending on the substance, it may be more likely to collect in cancer cells or in different types of adrenal tumors. The radiation can then be detected with a special type of camera, showing where the tumors are.

• Biopsy. If a doctor finds something that may be cancer, the doctor may want to take a small sample of the tumor with a hollow needle. This is called a biopsy. The sample taken during a biopsy is looked at under a microscope by a doctor, called a pathologist, who specializes in looking for cancer. The pathologist looks at the cells to see if cancer is present. However, doctors feel that a needle biopsy may actually spread the tumor cells, so it is not done before surgery, if the size and imaging studies suggest it is cancer. 

Getting a second opinion

Before starting treatment, you may want to have a second doctor review your diagnosis and treatment options. Remember that in most cases, a short delay in treatment will not lower the chance that the treatment will work. Some health insurance or managed care companies even require that cancer patients get a second opinion. Many others will pay for a second opinion if you ask for it.

You have a few ways to find a doctor who can give a second opinion:

• Ask your primary care doctor. Your doctor may be able to recommend a cancer specialist, such as a surgeon, medical oncologist, or radiation oncologist. Sometimes, these doctors work together at special cancer centers or hospitals. Do not be afraid to ask your doctor about a second opinion.

• Call the Cancer Information Service. You can reach the National Cancer Institute's Cancer Information Service at (800) 4-CANCER (800-422-6237). You can find out about treatment facilities, including cancer centers, and other programs supported by the National Cancer Institute.

• Consult The Official ABMS Directory of Board Certified Medical Specialists. This reference book lists doctors by state. It gives their specialty, background, and training. You can find it in most public libraries or view it online at www.abms.org.  

• Seek other options. You can also get the names of doctors from local medical societies, a nearby hospital or medical school, local cancer advocacy groups, and from other people who have had cancer. 

Remember: It's more important to make an informed decision about your health care team and treatment than a quick one. You should get all the information you feel you need in order to make the best choice for yourself.