Adrenocortical carcinoma is a cancer of the adrenal cortex. This is an uncommon disease. The adrenal gland is divided mainly into 2 parts. These are the adrenal cortex and the adrenal medulla. The adrenal cortex has the function of producing mineralocorticoids and glucocorticoids. They produce hormones such as aldosterone and cortisol. The adrenal cortex has 3 main zones, which include the following;
- Zona glomerulosa
- Zona fascicularis
- Zona reticularis
These layers produce different hormones, that performs different functions, and makes the body function well. The zona glomerulosa produces aldosterone, which helps the body regulate blood pressure. Aldosterone causes the reabsorption of sodium and water. The zona fasciculate produces glucocorticoids, such as cortisol and corticosterone. Lastly, the zona reticularis produces sex hormones, such as androgens, dehydroepiandrosterone, and so on. The carcinoma of the adrenal cortex presents with different conditions such as Cushing’s syndrome, Conn syndrome, feminization and so on. Some of the signs and symptoms of this disease depend on the age of the patient. The symptoms of children vary from that of adults. Overall, adrenocortical carcinoma leads to the excessive production of these hormones into the bloodstream. This carcinoma has the ability to spread to other parts of the body. This process is known as metastasis. Adrenocortical carcinoma has often invaded surrounding tissues and even organs that are distant from the adrenal gland. This disease is quite dangerous. However, the earlier it’s diagnosed, the better the prognosis. The overall survival rate is low, at about 20-35%. Researchers are carrying out a lot of studies, to identify the cancer stem cells involved in adrenocortical carcinoma, which would eventually be used in the treatment of the disease.
What Are The Types Of Adrenocortical Carcinoma?
There are two main types of adrenocortical carcinoma. These are
- Functioning adrenocortical carcinoma: This type of tumour increases the production of adrenal hormones. Patients affected by this type of a tumour present with an excessive amount of cortisol, testosterone, and aldosterone. As earlier mentioned, aldosterone regulates the level of sodium in the body.
- Nonfunctioning adrenocortical carcinoma: This type of a tumour does not increase the level of adrenal hormones in the body.
Studies have shown that majority of adrenal gland tumours are not cancerous. In fact, only 5-10% of cases of this disease are malignant.
What Are The Signs And Symptoms Of Adrenocortical Carcinoma?
The signs and symptoms of this disease depend on the type of hormone that is being produced excessively. Below are some of the common signs and symptoms of the disease;
- Testosterone and other androgens
- A surge in the production of this hormone would lead to conditions such as increased growth of the facial and body hair. This is usually more prominent in female patients.
- Voice: Females affected by this disease would also have a deepened voice, primarily due to the high production of testosterone.
- Estrogen
- As opposed to testosterone and other androgens, the effect of the excessive amount of estrogen is usually more prominent in males. The patient would present with enlarged breast tissue.
- Children also attain puberty earlier, because of the high level of estrogen.
- Aldosterone
- A high level of aldosterone causes patients to add an abnormal amount of weight.
- Patients also develop a high blood pressure. Aldosterone works by reabsorbing sodium into the blood. The high level of sodium leads to an increase in the blood pressure.
- Cortisol
- High level of cortisol leads to high blood sugar.
- The high amount of cortisol in the blood also leads to an increase in the blood pressure.
- The high level of cortisol in the blood leads to the weakness of the muscles of the legs.
- Patients might also present with bruising on their body.
- The high level of cortisol in the body cause patients to add an excessive amount of weight, especially in the chest and abdominal region of the body.
While nonfunctioning tumours do not produce any hormones, they can cause abdominal discomfort. The same applies to function tumours.
Who Is At Risk Of Developing Adrenal Cortical Carcinoma?
There are some factors that increase the risk of developing adrenal cortical carcinoma. Some of these risks are;
- Gender: According to research, it has been observed that adrenal cortical carcinoma tends to occur more in females. Although it also in males, it’s just more prevalent in the female gender.
- Age: Age also plays a role in the development of this disease. It has been noted that the adrenal cortical carcinoma occurs more in people between the ages of 40 and 50. In addition, children below the age of 5, also have a high risk of developing this disease.
- Heredity: There are some hereditary diseases that can affect the adrenal gland, increasing the risk of developing tumours.
- Secondary disease: As earlier mentioned, a lot of cases of adrenal cortical carcinoma is due to the spread of cancer from another part of the body to the adrenal gland.
How Is Adrenocortical Carcinoma Treated?
The physician would draw a treatment plan based on different factors. Some of them include the gender, age, and the general health status of the patient. In addition to this, the stage of the cancer is also an important factor in how the physician would manage the patient. Below are some of the various treatment plans that the physician could use;
- Chemotherapy: This is the process in which medications are used to kill the cancer cells. These drugs can be administered orally, or intravenously.
- Surgery: This is the process whereby the physician removes the adrenal gland and the tissues around it that are affected by the disease.
- Radiotherapy: This is the process in which radiations are used for the treatment of the disease. There are two types of radiotherapy; these are external radiation and internal radiation therapy. The external radiation therapy is applied outside the body, while the internal radiation is applied to the tumours directly, through the use of radioactive substances.
- Biologic therapy: This is the kind of therapy in which the immune system of the patient is used to eliminate the cancer cells.
Stem Cell Therapy
Scientists are presently working on understanding how cancer stem cells contribute to relapse and resistance to treatments. This is important in creating an effective therapy for the treatment of adrenal cancer.
References
Handler, J. (2003). Adrenal Carcinoma. The Journal of Clinical Hypertension, 5(5), pp.355-358.
Piecing Together the Adrenal Cancer Puzzle. (2016). Cancer Discovery, 6(7), pp.687-687.
Reichert, R., Schuch, A. and Luersen, G. (2015). Adrenal Collision Tumor: Renal Carcinoma Metastasis of Adrenal Adenoma. Clinical & Biomedical Research, 35(3), pp.169-171.
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