Diagnosis of adrenal gland cancer

Diagnosis is the process of finding out the cause of a health problem. Diagnosing cancer often means first ruling out other health conditions that share similar symptoms with cancer. It can be a very worrying time for you and your loved ones. Sometimes this process is quick. Sometimes it can feel long and frustrating. But it's important for doctors to get all the information they need before making a diagnosis of cancer.

Diagnosing adrenal gland cancer usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and do a physical exam. But many times adrenal gland tumours are found when imaging tests are done for other health reasons. Based on this information, your doctor may refer you to a specialist or order tests to check for adrenal gland cancer or other health problems.

The following tests are usually used to rule out or diagnose adrenal gland cancer. Many of the tests that are used to diagnose cancer are also used to find out how far the cancer has spread (the stage). Your doctor may also order other tests to check your general health and to help plan your treatment.

Your health history is a record of your symptoms and risks and all the medical events and problems you have had in the past. Your doctor will ask questions about your history of:

• symptoms that suggest adrenal gland cancer
• hereditary (inherited) conditions linked to an increased risk of adrenal gland cancer

Your doctor may also ask about a family history of adrenal gland cancer and other cancers.

A physical exam allows your doctor to look for any signs of adrenal gland cancer. During a physical exam, your doctor may:

• check your blood pressure
• feel your abdomen for enlarged organs or a lump

Find out more about physical exams.

Blood chemistry tests measure certain chemicals, such as hormones, in the blood. They show how well certain organs are working and can help find problems. Blood chemistry tests used to diagnose adrenal gland cancer may find one or more of the following results:

• A high level of cortisol may mean there is an adrenal gland tumour making cortisol.
• A high level of aldosterone may mean there is an adrenal gland tumour making aldosterone.
• A high level of testosterone or dehydroepiandrosterone sulphate (DHEAS) may mean there is an adrenal gland tumour producing androgens.
• A high level of estrogen may mean there is an adrenal gland tumour producing estrogen.
• A high level of follicle-stimulating hormone (FSH) means that there is probably not an adrenal gland tumour producing too much androgens or estrogen.
• Low levels of potassium and renin may mean there is an adrenal gland tumour producing too much aldosterone.
• A low level of adrenocorticotropic hormone (ACTH) and a high level of cortisol may mean there is a functional adrenal gland tumour. A functional tumour overproduces certain hormones.
• A high level of epinephrine or norepinephrine may mean there is a pheochromocytoma.
• High levels of metanephrine and normetanephrine may mean there is a pheochromocytoma.
• A high level of the protein chromogranin A in the adrenal medulla may mean there is a pheochromocytoma.

Find out more about blood chemistry tests.

Urine tests measure the levels of adrenal gland hormones and the products of their breakdown (called metabolites) in the urine.

A high cortisol level may mean that there is an adrenal gland tumour. High levels of metanephrine and normetanephrine may mean there is a pheochromocytoma.

A computed tomography (CT) scan uses special x-ray equipment to make 3D and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures.

A CT scan is used to:

• find a tumour in the adrenal gland
• find out if the cancer has spread and where it has spread
• help find out if a tumour is cancerous or non-cancerous based on its features, such as the size, the density and whether the edges are smooth or uneven

Find out more about CT scans.

Magnetic resonance imaging (MRI) uses powerful magnetic forces and radiofrequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3D pictures.

An MRI is used to:

• find out if the cancer has spread and where it has spread
• find out if there is a problem with the blood vessels
• help find out if a tumour is cancerous or non-cancerous based on its features, such as the size, the density and whether the edges are smooth or uneven

Find out more about MRIs.

A dexamethasone suppression test may be done to measure the cortisol level in the blood. A dose of dexamethasone (a type of corticosteroid) is taken by mouth to slow the production of cortisol. The blood cortisol level is measured 12 hours later.

If there is no adrenal gland tumour, the level of cortisol in the blood will be lower than normal.

If there is an adrenal gland tumour, the level of cortisol will be normal or high.

A positron emission tomography (PET) scan uses radioactive materials called radiopharmaceuticals to look for changes in the metabolic activity of body tissues. A computer analyzes the radioactive patterns and makes 3D colour images of the area being scanned. This PET scan is called an FDG glucose PET scan.

A PET scan may be used to:

• help find out if a tumour is cancerous or non-cancerous
• check for small groups of cancer cells
• find out if cancer has spread to other parts of the body

A special PET scan, called a gallium-68 DOTATATE somatostatin receptor PET scan can be used to diagnose pheochromocytomas.

Find out more about PET scans.

A metaiodobenzylguanidine (MIBG) scan is a nuclear medicine imaging test that uses small amounts of the radiopharmaceutical MIBG to help locate and diagnose certain types of cancer.

MIBG scans are used to find pheochromocytomas that develop in the inner layer of the adrenal gland (called the adrenal medulla). Tumours that develop in the outer layer of the adrenal gland (called the adrenal cortex) can't be seen with this test.

Find out more about MIBG scans.

A bone scan uses bone-seeking radioactive materials called radiopharmaceuticals and a computer to create a picture of the bones. It is used to find out if adrenal gland cancer has spread to the bones.

Find out more about bone scans.

During a biopsy, the doctor removes tissues or cells from the body so they can be tested in a lab. A report from a pathologist will show whether or not cancer cells are found in the sample.

A biopsy is not usually done for adrenal gland tumours because it's hard to see a difference between non-cancerous and cancerous adrenal gland tumour cells under a microscope. Also, a biopsy of an adrenal gland can cause serious problems such as excessive blood loss (hemorrhage), a collapsed lung (pneumothorax) and sudden increases in hormone levels (catecholamines).

A biopsy is done only if cancer is found but it isn't clear whether it started in the adrenal gland or spread to the adrenal gland from a different place (called secondary adrenal gland cancer). The following types of biopsies might be done.

Core biopsy uses a hollow needle or probe to remove a piece of tissue so it can be examined under a microscope. This type of biopsy is not usually done to diagnose adrenal gland tumours, but your doctor may decide it is needed. Core biopsies are commonly used to diagnose tumours in other parts of the body.

Fine needle aspiration (FNA) uses a very thin needle to remove a small amount of fluid or cells from a lump or mass. FNA is not usually done to diagnose adrenal gland tumours, but it can be used to diagnose tumours in other parts of the body.

Find out more about biopsies, fine needle aspiration (FNA) and core biopsy.

Find out more about a diagnosis. To make the decisions that are right for you, ask your healthcare team questions about diagnosis.