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Adrenal cancer
Staging and prognostic factors
Staging Techniques
CT or MRI can image the extent of disease and should include the
chest to rule out pulmonary metastases.
If the inferior vena cava is involved, either a cavagram or
ultrasonography is useful to assess extent of tumor.
Evaluation of local extent
For the evaluation of the local extent of the disease and regional
lymph node involvement please refer to CT and MRI imaging in the
diagnosis section.
Pulmonary metastasis (45%)
1. Chest x-ray
A chest radiograph in two planes is indicated on a regular basis
to screen for metastatic disease in the follow-up of patients with
primary tumors that preferentially spread to the lungs.
Benefits
- Sensitivity and specificity for chest radiography were 50
and 90%, respectively for nodules >5mm.
- It more accurately detects a 1-cm nodules 1cm or greater.
2. Chest CT
When metastatic nodules are identified, helical computed
tomography (CT) of the chest should be performed to assess
their number and characteristics.
Benefits
- A high-resolution CT scan can identify
nodules 3 mm in diameter.
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CT has an overall sensitivity 62% in detecting
pulmonary nodules (all sizes). However it underestimated the extent of the disease in 25%, and overestimated
the extent of the disease in 14%.
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Sensitivity is increased to 95% for
intrapulmonary nodules ≥ 6 mm and 100% for intrapulmonary nodules >
10 mm.
The limitations of CT scan in this study
were mainly associated with pleural-based nodules and intrapulmonary
nodules < 6 mm.
Liver metastasis (40%)
1. Ultrasonography of the liver
Ultrasonography is inexpensive and readily available, but its
value compared to single-slice helical CT (SSCT), MSCT, and MRI is
limited as a consequence of reduced sensitivity and specificity.
In general, the US appearance of liver metastases is nonspecific.
Benefits
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Sensitivity is operator dependent. It is valuable,
inexpensive, quick, and portable, and it can depict lesions as
small as 1 cm with a sensitivity approaching 80%.
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The specificity of US in detecting liver metastases
is poor, and its overall false-negative rate is 50%. However,
the presence of multiple hepatic nodules of different sizes
within the liver is nearly always due to metastases.
2. Abdominal CT
CT is the most sensitive technique for the detection of liver
metastases.
Benefits
- Contrast-enhanced scans offer a high degree of sensitivity,
as high as 80-90%. The specificity is 99%.
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Staging of adrenal cancer
Prognostic factors (Risk factors for recurrence)
The two main prognostic factors for adrenal cancer are completeness
of resection and stage of disease. Patients with evidence of invasion into local tissues
or spread to lymph nodes have a worse prognosis.
Patients
with carcinomas having a high mitotic rate (more
than 20 mitoses/10 HPF) have a shorter disease free
survival period than patients whose carcinomas
have a low mitotic rate (less than 20
mitoses/10 HPF).
Prognostic factors currently under investigation
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