Adrenal Surgery Overview
The adrenal gland is located on top of each kidney. It is divided into two sections: the adrenal medulla and the adrenal cortex. Each has a different function, but in general the overall function of the gland is to make steroid hormones.
Although there are two parts to the adrenal gland, the vast majority of malignancies of the adrenal gland occur in the cortex. Carcinomas of the adrenal gland are considered either functional or nonfunctional; that is, they either produce steroids (which may lead to clinical symptoms) or they don't. This disease is very rare, affecting 2 per 1 million people.
Staging This Disease
Staging allows the physician to gauge the amount of and the location of tumor in the body by using information gathered from imaging studies such as CT scans, MRIs, etc., as well as information from pathology and physical examination. Once a stage has been defined, the physician can make a prediction of how the patient may do over time, and determine what sort of therapy might be necessary.
There is no formally adopted staging system for adrenal carcinoma at this time. However, the one most often used places patients into one of four categories. Variables taken into account include: tumor size; presence or absence of invasion into the kidney or other nearby organs; the presence or absence of lymph node involvement; and the presence or absence of distant disease (such as lung, liver or bone involvement). Stages may be generally divided into the following:
Stage 1: Small tumors (less than 2 inches) without evidence of local invasion; absence of nodal involvement and absence of distant disease.
Stage 2: Tumors larger than 2 inches without evidence of local invasion; absence of nodal involvement and absence of distant disease.
Stage 3: Tumors of any size that exhibit nodal involvement.
Stage 4: A mixed group consisting of tumors that invade adjacent structures; any tumor that has evidence of distant spread; or any tumor that has invaded the kidney and has positive nodal involvement.
Prognosis is determined by the interaction of disease stage and aggressiveness as defined by number of cells dividing when examined under the microscope.