Adrenocortical carcinomas are curable if the diagnosis can be made before the tumor is larger than 5 cm (2 in.) and has not spread outside the adrenal gland. At the time of diagnosis, however, most people with adrenal cortical carcinomas (70 percent) have Stage III or Stage IV disease. The initial treatment for all stages, even Stage IV, is to surgically remove the entire tumor and sometimes the adjacent kidney. Radiation and chemotherapy may be used as adjuvant treatment after surgery, although the benefit of such treatment is difficult to assess.
The 70 percent of these cancers that produce hormones have a better prognosis than those that don't, but this is probably because the symptoms of excess hormone production lead to an earlier diagnosis. Patients who respond to mitotane also have a better prognosis but are rarely cured.
Surgery Removal of the entire tumor is the only treatment that can lead to a cure. This may
sometimes also require the removal of the adjacent kidney. As much of the primary tumor as possible is
removed, even if all of it can't be, to decrease the amount of hormones produced.
Prolonged remissions have been reported after the removal of metastatic disease in the liver, lung and brain. As with the primary tumor, even if all the metastases cannot be removed, it may still be beneficial to remove most of them, for this will remove the source of the hormones and these cancers may grow slowly.
Surgery to remove pheochromocytomas requires specific preparation and management before, during and after the operation. The management of patients with these tumors is complex, and the surgical and medical teams have to be familiar with the specific medical and pharmacologic measures needed to minimize the risk to the
