ADRENAL CANCER

Adrenal Carcinoma; Adrenocortical Cancer; Adrenocortical Carcinoma; Cancer of the Adrenal Cortex; Carcinoma of the Adrenal Cortex

Adrenal cancer is rare and forms in the outer tissue layer of the adrenal gland, the cortex. A tumor of the adrenal cortex may be functioning (producing excess hormones) or non-functioning (not producing hormones). A subtype of adrenal cancer, anaplastic, which shows no cellular differentiation, generally presents as “non-functioning tumor.” Individuals with the hereditary diseases LiFraumeni Syndrome, Beckwith-Wiedemann Syndrome, and Carney Complex are at risk for adrenal cancer.

Diagnostic testing: The diagnosis of adrenal cancer is made by:

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  Image guided fine needle biopsy;

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  Ultrasound;

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  X-rays;

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  Magnetic resonance imaging (MRI) scan;

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  Computed tomography (CT) scan;

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  Positron emission tomography (PET) scan;

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  Adrenal angiography; and

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  Laboratory tests including blood and urinalysis to measure levels of adrenal hormones, cortisol levels, aldosterone levels, and androgen or estrogen levels.

Physical findings: Symptoms and physical findings of individuals with adrenal cancer may include:

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  Development of masculine or feminine features, due to hormone increases;

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  Generalized weakness;

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  Nausea;

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  Abdominal pain;

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  Swelling or weakening of bones or muscles;

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  High blood pressure;

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  Fluid retention; and

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  Electrolyte abnormalities in the body.

ICD-9: 194.0

ICD-10: C79.70

The 5-year survival rate for inoperable or unresectable tumors is less than 10%.

Treatment may include surgery, radiation, or chemotherapy. Palliation can be used for inoperable or unresectable tumors, but the prognosis is poor.

Suggested MER for Evaluation:

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  Clinical history and examination that describes the diagnostic features of the impairment;

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  A pathology report noting that the surgical specimen has positive margins, or is inoperable, unresectable, recurrent, or with metastases; and

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  An operative report.

“Inoperable” refers to a physician's opinion that surgery would not be beneficial based on a review of imaging studies, laboratory results, and physical examination findings.

“Unresectable” cancer is established when the operative report indicates that the cancer is not completely removed or the pathology report notes that the surgical specimen has positive margins.

Suggested Listings for Evaluation:

REMARKS

Adrenal cancer that is inoperable, unresectable, recurrent, or with metastases meets listing13.21.