Adrenocortical Carcinoma
Adrenocortical Carcinoma Definition
Adrenocortical carcinoma also called as ACC or adrenal cortical carcinoma and adrenal cortex cancer is a cancer that is aggressive which originates from the cortex (a tissue that produces steroid hormones) of the adrenal gland. Adrenocortical carcinoma is a tumor that is rare with an incidence of 1-2 in every 1,000,000 individuals annually. ACC has a bimodal allocation by age (most of the cases cluster among children that are under the age of 6 and in adults at 30-40 years of age). ACC can result into many syndromes such as Cushing's syndrome, virilization, Conn syndrome, and feminization. It also commonly metastizes or invades neighboring tissues and the survival rate is estimated at only 20-35%.
Adrenocortical Carcinoma Diagnosis
Laboratory testing could confirm hormonal syndromes. Cushing syndrome laboratory results include an increase in blood sugar (serum glucose) and a heightened urine cortisol. Confirmation of adrenal virilism is done by findings such as excessive dehydroepiandrosterone and serum androstenedione. Conn syndrome findings include potassium serum that is low, low activities of the plasma renin, and a high level of serum aldosterone. Finding an excess in serum estrogen normally confirms feminization. Abdominal radiological studies such as MRI or CT scans are useful in identifying the tumor site, knowing its differentiation from other illnesses and pointing out the invasion extent of the carcinoma in neighboring tissues and organs. Metastases of the bones or lungs can be diagnosed with the help bone and chest CT scans. These are able to provide information as to the treatment that will be used (especially if the process involves surgically removing the carcinoma).
Adrenocortical Carcinoma Symptoms and Signs
Adrenocortical carcinoma may have different manifestations in adults and children. Most of the tumors are functional in children and it is virilization that is the main symptom which is followed by precocious puberty and Cushing's syndrome. Adults have manifestations of hormonal syndromes and Cushing's syndrome is common. Conn syndrome and feminization are rare at only 10% of the cases. The rare symptoms for adrenocortical cancers include over secretion of catecholamines which is like pheochromocytoma. Tumors that are non-functional often present with flank or abdominal pain or they could be asymptomatic and detection is incidental. All patients with suspected ACC should be tested for signs of hormonal syndromes.
Adrenocortical Carcinoma Treatment
A complete tumor surgical excision is the only treatment that can cure ACC. This can be performed even when the ACC has invaded blood vessels such as the renal vein and the inferior vena cava. 50-60% is the survival rate after the surgical procedure. Regimens of chemotherapy and hormonal therapy are also used to reduce the manifestation of symptoms.