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How We Diagnose Adrenocortical Carcinoma

  • At a Glance

    Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC) offers a multidisciplinary team of experts in genitourinary oncology to provide the best care possible.

    • There are many imaging studies and tests available that examine blood and urine to detect and diagnose adrenocortical carcinoma. Our team will walk through all options with you.
    • After adrenocortical cancer has been diagnosed, tests are done to determine tumor’s size and if it has spread beyond the adrenal gland.
    • Once the stage of adrenocortical carcinoma has been established, our team will create a personalized treatment plan with you.

    Receiving an accurate diagnosis is important in determining the best treatment. The majority of adrenocortical carcinoma patients are diagnosed when excess steroid hormone or an abdominal mass is detected, though 15 to 20% of patients are diagnosed during a routine exam or blood test.

    At DF/BWCC's Lank Center for Genitourinary Oncology, we understand the fear and stress of facing a potential cancer diagnosis. Our team will work closely with you to explain the entire process and answer any questions.

    Second Opinions

    Our diagnostic team provides second opinions, including for challenging or difficult cases. We are happy to consult with you and your local care team on the best approach to care, which often enables patients to be treated close to home, with input from the DF/BWCC team.

    You may want to consider a second opinion:

    • To confirm your diagnosis.
    • For an evaluation of an uncommon presentation.
    • For details on the type and stage of cancer.
    • To better understand your treatment options.
    • To learn if you are eligible for clinical trials.

    Phone: 877-442-DFCI or 877-442-3324
    Online: Complete the Appointment Request Form

    If you cannot travel to Boston in person, you can take advantage of our Online Second Opinion service.

    Diagnostics

    Imaging studies and tests that examine the blood and urine are used to detect and diagnose adrenocortical carcinoma.

    The tests and procedures used to diagnose adrenocortical carcinoma depend on your signs and symptoms. Our physicians will work closely with you to explain our individualized approach to testing. The following tests and procedures are commonly used to diagnose adrenocortical carcinoma:

    • Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. The sample may be taken using a thin needle, called a fine-needle aspiration (FNA) biopsy or a wider needle, called a core biopsy. A biopsy is required prior to an appointment at DF/BWCC.
    • Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of your health habits and past illnesses and treatments will also be reviewed.
    • Twenty-four-hour urine test: Urine is collected for 24 hours to measure the amounts of cortisol or 17-ketosteroids. A higher than normal amount of these in the urine may be a sign of disease in the adrenal cortex.
    • Blood chemistry study: This procedure uses a blood sample to measure the amounts of certain substances, such as potassium or sodium, released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease.
    • CT scan (CAT scan): This procedure makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues display more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
    • MRI (magnetic resonance imaging): This procedure uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. It is also called nuclear magnetic resonance imaging (NMRI). An MRI of the abdomen is done to diagnose adrenocortical carcinoma.
    • Adrenal angiography: This procedure uses a contrast dye injected into the adrenal arteries to look at the arteries and the flow of blood near the adrenal glands. As the dye moves through the arteries, a series of x-rays is taken to see if any arteries are blocked.*
    • Adrenal venography: In this procedure, a contrast dye is injected into an adrenal vein to look at the adrenal veins and the flow of blood near the adrenal glands. As the contrast dye moves through the veins, a series of x-rays is taken to see if any veins are blocked. A catheter (very thin tube) may be inserted into the vein to take a blood sample, which is checked for abnormal hormone levels.*
    • PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.*
    • MIBG scan: A very small amount of radioactive material called MIBG is injected into a vein and travels through the bloodstream. Adrenal gland cells take up the radioactive material and are detected by a device that measures radiation. This scan is done to tell the difference between adrenocortical carcinoma and pheochromocytoma.*
    • Dexamethasone suppression test: A test in which one or more doses of dexamethasone are given. The level of cortisol is checked from a sample of blood or from urine that is collected for three days. This test checks if the adrenal gland is making too much cortisol, or if the pituitary gland is telling the adrenal glands to make too much cortisol.*

    *These tests are administered on a case-by-case basis.

    Staging

    After adrenocortical carcinoma has been diagnosed, tests are done to find out if cancer cells have spread within the adrenal gland or to other parts of the body. This is called staging.

    The information gathered from the staging process determines the stage of the disease, which is important to know when planning treatment. The following tests and procedures may be used in the staging process:

    • CT scan (CAT scan).
    • MRI (magnetic resonance imaging) with gadolinium: A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body, such as the abdomen. A substance called gadolinium may be injected into a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).
    • PET scan (positron emission tomography scan) .
    • Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs, such as the vena cava, and make echoes. The echoes form a picture of body tissues called a sonogram.
    • Adrenalectomy: A procedure to remove the affected adrenal gland. A tissue sample is viewed under a microscope by a pathologist to check for signs of cancer.

    Stages

    • Stage I indicates the tumor is smaller than 2 inches (5 centimeters) and has not spread beyond the adrenal gland.
    • Stage II indicates the tumor is larger than 2 inches (5 centimeters) but has not yet spread.
    • Stage III indicates the tumor has spread to nearby lymph nodes, tissues, organs (kidney, diaphragm, pancreas, spleen, liver) or to large blood vessels (renal vein or vena cava). Size is not a factor.
    • Stage IV indicates the tumor may be any size, may have spread to nearby lymph nodes, and has spread to other parts of the body, such as the lung, bone, or peritoneum.