Adrenal Cancer: Surgery

Surgery to remove one or both adrenal glands is called an adrenalectomy. It's the main treatment for adrenal cancer. It offers the best chance for cure. During this surgery, nearby tissues and lymph nodes may be removed, too.

Depending on where the adrenal cancer has spread, surgery might include removing tumors in other parts of the body. This can help ease symptoms caused by the tumors. It might also be done to find out what these other tumors are.

Removing the adrenal gland with cancer may be done in two ways:

• Open surgery. A large cut (incision) is made in the skin. Where the incision is depends on the size of the tumor and if the cancer has spread. For small tumors, the incision may be made in the back, just below the ribs. For larger tumors, the incision is made in the front of the belly. This is more common because it's easier to see the adrenal gland and the tissues around it. It allows the doctor to look for and remove tumors that have spread to other organs, like the kidney or part of the liver. It also allows the doctor to reach both adrenal glands through one incision.
• Laparoscopy. This type of surgery is more commonly used. It may be used if the tumor is not very large and has not spread. It's done through several small incisions using a thin, flexible tube called a laparoscope. The laparoscope has a light and camera. It's put into one of the incisions so the doctor can see the area on a computer screen. Long, thin tools are then put into the other incisions and used to take out the tumor. There are several advantages of laparoscopic surgery, including possibly less pain, less time in the hospital, and smaller scars.

All surgery has risks. The risks of adrenal cancer surgery include:

• Excess bleeding
• Pain as you recover
• Infection
• Damage to nearby organs
• Organs bulging under the incision (incision hernia)
• Blood clots
• A reaction to general anesthesia

Your risks depend on your overall health, the type of surgery you need, and other factors. Talk with your doctor about your risks. Also ask about what side effects you might expect.

Your health care team will talk with you about the surgery choices that are best for you. You may want to bring a family member or close friend with you to appointments. Write down questions you want to ask about your surgery. Make sure to ask:

• What type of surgery will be done
• What will be done during surgery
• The risks and possible side effects of the surgery
• When you can return to your normal activities
• If the surgery will leave scars and what they will look like
• What types of hormone imbalances you can expect and how they'll be treated

Follow any directions you are given for not eating or drinking before surgery.

Tell your health care team if you are taking any medicines. This includes over-the-counter medicines, prescription medicines, vitamins, herbs, other supplements, marijuana, and illegal drugs. This is to make sure you're not taking anything that could affect the surgery. After you have discussed all the details with the surgeon, you'll sign a consent form. This says that the doctor can do the surgery.

You'll also meet the anesthesiologist. This is the doctor who will give you medicine (called anesthesia) during surgery so you're in a deep sleep and don't feel pain. You can ask questions about the anesthesia and how it will affect you. After you have discussed all the details about your anesthesia, you will sign a consent form for anesthesia. Just before your surgery, an anesthesiologist or a nurse anesthetist will start the medicine.

You may have to stay in the hospital for up to 7 days. It depends on the type of surgery you have. For the first few days after surgery, you'll have some pain from the incision. Your pain can be controlled with medicine. Talk with your doctor or nurse about your pain relief choices. Some people don't want to take pain medicine. But taking medicine can help your healing. If you don't control pain well, you may not want to cough, turn over often, or get out of bed. These are important things you need to do as you recover from surgery to prevent complications.

You may have constipation from using pain medicine, from not moving much, or from not eating much. Talk with your doctor or nurse about getting more dietary fiber or using a stool softener.

You may feel tired or weak for a while. The amount of time it takes to recover from surgery varies for each person.

A type of adrenal cancer called pheochromocytoma may release a lot of hormones. You'll be watched closely for any high blood pressure problems before, during, and after surgery.

You may need to start taking hormone replacement medicine after surgery. You might need to do this for the rest of your life.

When you get home, you may get back to light activity. Your health care team will tell you what kinds of activities are safe for you while you recover.

Here are some common activity do's and dont's:

• Do rest when you are tired. Don't worry if you are extremely tired (fatigued). Fatigue and weakness are normal for a few weeks. This will get better over time. Limit your activity to short walks. Slowly increase your pace and distance as you feel able.
• Don't do any strenuous activities, such as mowing the lawn, using a vacuum cleaner, working out, or playing sports. Listen to your body. If an activity causes pain, stop. Deep breathing may cause some pain at the cut (incision) site for a few weeks. This is normal.
• Don't drive until you are free of pain and no longer taking prescription pain medicine. This may take 2 to 4 weeks.
• Don't sit with your legs hanging down and don't stand still for long periods.
• Don't lift anything heavier than 10 pounds until your doctor says it's okay to do so.

You'll be taught how to care for your incision(s). For example, you may be told to:

• Leave the small, white, wound-closure strips over your incision in place for 7 to 10 days after your surgery.
• Always keep your incision clean and dry.
• Shower as needed. Wash your incision gently with mild soap and warm water and pat dry. Don't scrub your incision.

Other home care directions might include:

• Check your temperature every day for 7 days after your surgery.
• Go back to your regular diet as you feel able. Try to eat a healthy, well-balanced diet.
• Try to prevent constipation by eating fruits, vegetables, and whole grains and drinking 6 to 8 glasses of water a day, unless directed otherwise. Use a laxative or a mild stool softener if your doctor says it's okay.

You may need more treatment after surgery. Your doctor will talk with you about this.

If you need to take hormone therapy after surgery, you may be referred to an endocrinologist. This is a doctor who specializes in treating disorders of the hormone (endocrine) system.

Be sure you know what your next steps are and you have all the follow-up appointments you need.

Contact your doctor right away if you have any of these problems after surgery:

• Any new or abnormal bleeding
• Redness, swelling, warmth, or fluid leaking from the incision
• Incision opens up or the edges pull apart
• New pain or pain that's getting worse or not helped by your pain medicine
• Fever of 100.4°F (38°C) or higher, or as advised by your doctor
• Chills
• Cough or shortness of breath
• Trouble or pain in passing urine or changes in how your urine looks or smells

Talk with your doctor about any other problems to watch for and when to call them. Know what number to call with questions. Find out if there is a different number to call after office hours, on weekends, and on holidays.