When Lung Cancer Spreads to the Adrenal Glands

Lung cancer spread to the adrenal glands is known as adrenal metastasis. This is fairly common and present in 2% to 3% of people at the time of their primary cancer diagnosis. On rare occasions, adrenal metastases are the first sign of lung cancer.

Lung cancer that spreads to the adrenals or any other area of the body is considered stage 4, which is advanced. But adrenal metastasis that occurs on the same side of the body as the original tumor has a better outlook than lung cancer that spreads to other sites.

This article discusses possible indications that lung cancer has spread to the adrenal glands, how healthcare providers diagnose and treat such cases, and what this means in terms of your prognosis.

Top Cause of Cancer Spread to the Adrenals

Nearly any cancer can spread to the adrenal glands, but some tumors are more likely than others to metastasize to this region.

According to a study published in the Journal of Thoracic Oncology, the cancers most responsible for adrenal metastases are lung cancer (35%), stomach cancer (14%), esophageal cancer (12%), and liver cancer (10%).

Other common cancers that spread to this region include kidney cancer, melanoma, breast cancer, colon cancer, and lymphoma.

About 40% of people with lung cancer will develop adrenal metastases at some time. Of those with non-small cell lung cancer, 10% experience disease spread to both adrenal glands.

Symptoms of Adrenal Metastasis Due to Lung Cancer

Most of the time when cancer spreads to the adrenal glands there aren't any symptoms. In fact, in one study, only 5% 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, MRI, or PET scan.

When symptoms are present, they may include:

• Back pain (in the mid-back region)
• Abdominal pain
• Bleeding into the abdomen (hemorrhage)

It can also cause adrenal insufficiency also known as Addison's disease. Symptoms of Addison's disease include:

• Weakness
• Low blood pressure (hypotension)
• Low blood sugar (hypoglycemia)
• Low sodium level in the blood (hyponatremia)
• High potassium level (hyperkalemia)

Addison's disease develops in rare cases when both adrenals are significantly affected by malignancy.

Diagnosis

If you have a scan suspicious for adrenal metastases, you won't necessarily need any further evaluation, especially if you have metastases to other regions of your body.

In some cases, your healthcare provider 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.

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 is important for all.

Supportive Care

Whether or not you and your healthcare provider 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

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. If back pain or abdominal pain occurs, this should be treated.

Treatment of the Primary Tumor

Treating stage 4 lung cancer may include chemotherapy, targeted therapies, immunotherapy, and/or radiation therapy. Some people also participate in clinical trials studying new drugs and procedures.

The addition of targeted therapies and immunotherapy have changed the face of advanced lung cancer for many people in recent years.

An example is ALK-positive lung cancer. A 2018 study found that, with appropriate treatment, the median survival of people with stage 4 disease was 6.8 years, even if they had brain metastases.

Immunotherapy, when effective, has sometimes even resulted in a durable response, holding lung cancer in check for a lengthy period of time. Since the first drug in this category was only approved in 2015, it is not yet known if the remissions that are sometimes seen will last—or what long-term outcomes may be.

Treatment With a Curative Intent

For people with an isolated adrenal metastasis, treatment may potentially result in long-term survival. Options include:

Surgery

Both open and laparoscopic adrenalectomy (removal of an adrenal gland) may be done with a curative intent for some people.

Stereotactic Body Radiotherapy (SBRT)

If surgery isn't possible, studies suggest that SBRT may be effective and well tolerated. SBRT involves using a high dose of radiation to a small area and sometimes has results similar to surgery.

In a 2018 study, local treatment of lung cancer adrenal metastases with SBRT resulted in overall survival rates at six months, one year, and two years of 85.8%, 58.1%, and 54%, respectively.

Ablation

Image-guided percutaneous ablation is yet another option. A 2018 study found that, although survival was poorer for those with non-small cell lung cancer who underwent the procedure than with some other cancers, image-guided percutaneous ablation of adrenal metastases may extend local progression-free survival as well as overall survival.

In the study, the average overall survival (for all tumor types combined) at one, three, and five years post-procedure was 82%, 44%, and 34%, respectively.

Prognosis of Lung Cancer Spread to Adrenals

Without treatment, the median survival following a diagnosis of adrenal metastases depends on the type of malignancy and the presence and location of other metastases.

With that said, studies evaluating the aggressive surgical treatment of adrenal metastases done today have been encouraging. Older research does not reflect the many new treatments for lung cancer that have been approved in just the past few years.

The researchers further reported that people with contralateral adrenal metastasis— cancer occurring on the opposite side of the body—had a five-year survival of zero.

Why Prognoses Vary

The answer to why certain adrenal metastases have a better prognosis may be in how cancer spreads through the body. Broadly speaking, cancer spreads in three distinct ways:

• As a tumor invades nearby tissue
• As cancer cells break off and travel through the lymphatic system
• As cancer cells break off and travel through the bloodstream

Ipsilateral (same-sided) adrenal metastases are believed to be associated with the lymphatic system, while contralateral (opposite-sided) adrenal metastases are believed related to the bloodstream.

When cancer cells spread through the lymphatic system, they are stopped along the route by lymph nodes that filter lymph fluid. Because of this, cancer is more likely to reach the adrenal gland in a direct path, typically on the same side of the body.

By contrast, when cancer cells enter the bloodstream, they circulate again and again throughout the body without stopgaps. Doing so typically results in more widespread disease as multiple organs are exposed to the circulating cancer cells.

Coping

If you've been diagnosed with stage 4 lung cancer and adrenal metastases, take time to learn about your cancer. Participating in the lung cancer community online is very helpful.

Newer treatments are improving survival rates, but the treatment of lung cancer is changing so rapidly that is hard for anyone to stay on top of the latest findings.

If you want to keep abreast of cutting-edge research, the hashtag #lcsm can help plug you into the lung cancer social media stream.

You may also wish to consider a second opinion at one of the larger National Cancer Institute-designated cancer centers, where oncologists who specialize in lung cancer have access to the latest research and clinical trials available.

Even if the second opinion backs up what you already know, it may help you feel more confident about your next steps.