Lung Cancer Spread to Adrenal Glands

Coping with Adrenal Metastases from Lung Cancer

imagining showing the adrenal glands at the top of the kidneys
What happens when lung cancer spreads to the adrenal glands?. istockphoto.com

If you've been told that your lung cancer has spread to your adrenal glands (adrenal metastases) you may be feeling confused. Unlike the spread of cancer to other areas, such as the liver, spread to the adrenal glands isn't talked about as frequently. Where are the adrenal glands and what does it mean if your lung cancer spreads to this location?

Overview

The adrenal glands are small triangular shaped glands that are located on top of each kidney.

These endocrine glands are responsible for secreting hormones, including "stress hormones" such as cortisol, epinephrine (adrenaline), and norepinephrine.  

Cancers That Spread to Adrenal Glands

Nearly any cancer can spread to the adrenal glands, but some tumors are more likely than others to spread to this region. In one study, the most common cancer responsible for adrenal metastases was the lung (35 percent) followed by stomach cancer (14 percent) esophageal cancer (12 percent) and liver/bile duct cancer (10 percent.) Other common cancers that spread to this region include kidney cancer, melanoma, breast cancer, colon cancer, and lymphoma.

If lung cancer has spread to the adrenal glands, it is considered stage 4 non-small cell lung cancer (or extensive stage small cell lung cancer.)  In recent years, however, it's been noted that some people - especially those with an isolated adrenal metastasis - aggressive surgical treatment of the metastasis may result in long-term survival.

As discussed further below, the prognosis for adrenal metastases from lung cancer may be better than the prognosis of other metastasessuch as those to the liver, brain, and bones.  

Incidence of Adrenal Metastases

Up to 40 percent of people with lung cancer will develop adrenal metastases at some time, and in 10 percent of people with non-small cell lung cancer, the disease spreads to both adrenal glands.

These metastases are present in 2 to 3 percent of people at the time of diagnosis, and on rare occasions are the first sign of lung cancer.

Symptoms

Most of the time when cancer spreads to the adrenal glands there aren't any symptoms. In fact, in one study only 5 percent of people with adrenal metastases had symptoms. People are most often only aware of these metastases due to radiology studies such as a CT scan or MRI.

When symptoms are present, these may include:

  • Back pain
  • Abdominal pain
  • Bleeding into the abdomen (hemorrhage)
  • Adrenal insufficiency (Addison's disease) - Symptoms of Addison's disease may include weakness, low blood pressure (hypotension), low blood sugar (hypoglycemia), a low sodium level in the blood (hyponatremia), and a high potassium level (hyperkalemia).

Diagnosis 

If you have a scan suspicious for cancer spread to your adrenal glands, you won't necessarily need any further evaluation, especially if you have metastases to other regions of your body. In some cases, your doctor may wish to be certain that a mass in your adrenal gland is due to metastatic cancer, and recommend a CT-guided biopsy.

Treatment

The treatment recommended for adrenal metastases can vary depending on several factors.

For all people supportive care is important. In people with symptoms such as hemorrhage, treatments such as surgery may be necessary to control symptoms. In some people, treatment with the goal of curing cancer may be a possibility.

  • Supportive Care - Whether or not you and your doctor decide upon further treatment of your cancer or your adrenal metastases, caring for your symptoms remains paramount. People with cancer deserve good pain management and control of other symptoms related to cancer.
  • Treatment of Symptoms - As noted above, adrenal metastases rarely cause symptoms. If a metastasis is bleeding (hemorrhaging) or is at high risk of bleeding, surgery to remove the tumor and adrenal gland (adrenalectomy) may be recommended. If the metastasis has resulted in adrenal insufficiency, treatment with steroids may be needed.
  • Treatment of the Primary Tumor and Other Metastases - This may include chemotherapy, targeted therapies or radiation therapy. Some people also participate in clinical trials studying new drugs and procedures. 
  • Treatment with Curative Intent - For people with an isolated adrenal metastasis, treatment may potentially result in long-term survival. Surgery - both open and laparoscopic adrenalectomy - may be done with a curative intent for some people  If surgery isn't possible, studies suggest that stereotactic body radiotherapy (SBRT) may be effective and well tolerated. 

Prognosis

Without treatment, the median survival following a diagnosis of adrenal metastases was only 3 months in one study. That said, and unlike metastases to other regions of the body, treatment of these metastases in selected people with non-small cell lung cancer has resulted in long-term survival.

Several small studies evaluating the treatment of adrenal metastases have been encouraging. For example, in one study of 37 patients, overall survival was 34 percent for those patients who had surgery, but 0% for those who did not have surgery. Another recent study found that long-term survival was possible in 25 percent of participants who were treated for adrenal metastases.

With small cell lung cancer, a study found that unlike metastases to the liver, brain, bone, and pleural fluid, metastases to the adrenal gland were not an unfavorable prognostic sign.

Why Might Prognosis Be Better for Adrenal Metastases Than Other Metastases?

The answer to this question may be how cancer spreads to arrive at the adrenal glands. Cancer spreads in 3 primary ways. One is locally near the tumor. Another is through the lymphatics. And the third is through the bloodstream. When cancer cells enter the bloodstream they travel throughout the body. In one study evaluating the effective of adrenalectomy on survival, it was found that with "ipsilateral disease" - that is, the spread of cancer to the adrenal gland on the same side of the body as the lung cancer - the 5-year survival rate was 83 percent. In contrast, the 5-year survival rate for people with "contralateral metastases" - adrenal metastases on the opposite side of the body from the lung cancer, the 5-year survival rate with surgery was 0%  It's thought that when lung cancer spreads to the adrenal gland on the same side of the body it reaches the adrenal gland by way of the lymphatic system. In contrast, when the adrenal gland on the opposite side of the body is affected it likely travels via the bloodstream (hematogenous spread) to arrive at the adrenal glands and the outcome is not as good.

Sources:

Bastian, S. et al. Surgical resection of isolated adrenal metastases in patients with non-small cell lung cancer: a single-institution experience and review of the literatureOnkologie. 2011. 34(12):665-70.

Bazhenova, L. et al. Adrenal metastases in lung cancer: clinical implications of a mathematical modelJournal of Thoracic Oncology. 2014. 9(4):442-6.

Hwang, E. et al. Prognostic factors for recurrence-free and overall survival after adrenalectomy for metastatic carcinoma: a retrospective cohort pilot studyBMC Urology. 2014. 14:41.

Nakazawa, K. et al. Specific organ metastases and survival in small cell lung cancerOncology Letters. 2012. 4(4):617-620.

Raz, D. et al. Outcomes of patients with isolated adrenal metastasis from non-small cell lung cancerAnnals of Thoracic Surgery. 2011. 92(5):1788-92.

Riiimaki, M. et al. Metastatic sites and survival in lung cancerLung Cancer. 2014 Aug 2. Epub ahead of print.

Continue Reading