Adrenocortical carcinoma: Diagnosis & Treatments
Diagnosis
Adrenocortical carcinoma is a rare cancer that occurs in one to two patients per million per year. Adrenocortical carcinoma is thought to be a very malignant tumor, but it exhibits very different biological and clinical characteristics for each individual. Patients with large, suspected adrenal tumors should be treated with a multidisciplinary team of medical professionals including endocrine, cancer, surgeon, radiologist, and pathologist. A suspected adrenocortical carcinoma is not an indication for FNA. First, malignancy and benignity of the adrenal mass can not be distinguished either cytologically or pathologically. Second, FNAs invade cancer capsules and can lead to cancer metastasis. It is difficult to distinguish benign from malignant pathologically even when the whole cancer mass is present. The most commonly used pathological category is Weiss Score. Weiss Score considers high nuclear grade, rate of dissection (> 5 / HPF), atypical cleavage, clear cell of 25% or more, diffuse configuration, presence of necrosis, invasion of the vein, and invasion of the cancer capsule. Adrenocortical carcinoma can be estimated at more than three positive. Although 60-70% of ACCs have biochemical steroid overdoses, clinically it is not well understood because the steroid secretion process is inefficient in cancer cells of many patients. Malignant tumors can be suspected when adrenal tumors secrete multiple types of corticosteroids.
Treatments
Treatment of adrenocortical carcinoma is only possible with early detection and complete removal. Capsule involvement in primary surgery, already metastatic status at diagnosis, and receiving primary care in non-specialist hospitals are the main contributors to poor survival. If the tumor invades the surrounding organs, it may be considered to remove the kidney and spleen collectively to reduce the risk of recurrence. Patients with metastases may also consider surgery when hormone excess associated with cancer is present. This should be taken into consideration, such as complications such as embolism, which is a risk factor for surgery, and delays in other treatment options. Patients with confirmed adrenocortical carcinoma who have successfully removed primary carcinoma receive adjuvant therapy, including mitotane. Patients with a high risk of recurrence (tumor size> 8 cm, pathologic findings of vascular invasion, capsule invasion, and Ki-67 proliferation index> 10%) should be considered for adjuvant therapy. Adjuvant mitotane should last for at least two years if the patient can tolerate side effects.
Adrenocortical carcinoma is a rare cancer that occurs in one to two patients per million per year. Adrenocortical carcinoma is thought to be a very malignant tumor, but it exhibits very different biological and clinical characteristics for each individual. Patients with large, suspected adrenal tumors should be treated with a multidisciplinary team of medical professionals including endocrine, cancer, surgeon, radiologist, and pathologist. A suspected adrenocortical carcinoma is not an indication for FNA. First, malignancy and benignity of the adrenal mass can not be distinguished either cytologically or pathologically. Second, FNAs invade cancer capsules and can lead to cancer metastasis. It is difficult to distinguish benign from malignant pathologically even when the whole cancer mass is present. The most commonly used pathological category is Weiss Score. Weiss Score considers high nuclear grade, rate of dissection (> 5 / HPF), atypical cleavage, clear cell of 25% or more, diffuse configuration, presence of necrosis, invasion of the vein, and invasion of the cancer capsule. Adrenocortical carcinoma can be estimated at more than three positive. Although 60-70% of ACCs have biochemical steroid overdoses, clinically it is not well understood because the steroid secretion process is inefficient in cancer cells of many patients. Malignant tumors can be suspected when adrenal tumors secrete multiple types of corticosteroids.
Treatments
Treatment of adrenocortical carcinoma is only possible with early detection and complete removal. Capsule involvement in primary surgery, already metastatic status at diagnosis, and receiving primary care in non-specialist hospitals are the main contributors to poor survival. If the tumor invades the surrounding organs, it may be considered to remove the kidney and spleen collectively to reduce the risk of recurrence. Patients with metastases may also consider surgery when hormone excess associated with cancer is present. This should be taken into consideration, such as complications such as embolism, which is a risk factor for surgery, and delays in other treatment options. Patients with confirmed adrenocortical carcinoma who have successfully removed primary carcinoma receive adjuvant therapy, including mitotane. Patients with a high risk of recurrence (tumor size> 8 cm, pathologic findings of vascular invasion, capsule invasion, and Ki-67 proliferation index> 10%) should be considered for adjuvant therapy. Adjuvant mitotane should last for at least two years if the patient can tolerate side effects.
