Surgery
Surgery is most important for stages I to III. We try to remove the tumor as completely as possible. In stage IV, this is no longer possible in all probability. We remove the adrenal gland together with the tumor in an open operation. The surgical procedure is called an “adrenalectomy”. It is the only therapy that is still aimed at curing the cancer. However, there is a high risk of adrenocortical cancer returning (relapse, recurrence). Therefore, surgery alone is not enough and other treatments are used.
Mitotane as a drug
The active substance mitotane has been approved for the treatment of adrenocortical carcinoma for many years and is considered the standard medication for advanced, metastatic adrenocortical carcinoma. Mitotan is also said to protect against relapses after an operation. Those affected take the medicine in tablet form.
The drug’s mechanism of action has not yet been precisely decoded. However, we know that mitotane causes cells in certain areas of the adrenal gland to die, inhibits hormone production there and accelerates the breakdown of adrenal hormones in the liver. In this way, we try to slow down the progression of the tumor and at best even shrink it. Excessive hormone production can also usually be controlled with Mitotan. The drug should also improve the effectiveness of chemotherapy if we use the cytostatic drugs at the same time.
Further treatments for adrenocortical carcinoma
Irradiation of the tumor bed after an operation can also be helpful. In this way, we try to destroy any remaining cancer cells locally.
Chemotherapy can also be a treatment option. We use powerful cytotoxins (cytostatics, chemotherapeutics) that attack cancer cells in various ways. There are several cytostatic drugs that are usually used in combination. Examples are doxorubicin, cisplatin or etoposide. Chemotherapy can also be combined with mitotane.
Liver metastases
All patients with adrenocortical carcinoma should undergo regular check-ups. A period of three months is recommended. As part of follow-up care, we check the patient’s state of health, alleviate symptoms and look for signs of recurrence. After two years without a relapse, we usually extend the time intervals to six months. However, you should still attend regular check-ups because there is a risk of relapse.
