Adrenocortical Carcinoma, from the CureRays guide library.

Adrenocortical carcinoma is a rare, aggressive cancer of the adrenal gland's outer layer that often overproduces hormones; complete surgery offers the best chance of cure, usually followed by the adrenal-specific drug mitotane, with radiation used to reduce local recurrence.

What it is.

Adrenocortical carcinoma (ACC) is a rare cancer that begins in the cortex — the outer, hormone-producing layer — of an adrenal gland, the small gland that sits on top of each kidney. Many of these tumors are 'functioning,' meaning they make excess hormones such as cortisol or androgens; this can cause weight gain, high blood pressure, easy bruising, diabetes, or hormonal changes that often bring the tumor to attention. Others are found because they grow large enough to cause pain or are spotted incidentally on a scan. ACC is aggressive and tends to recur, so treatment is intensive and coordinated by an expert center. The single most important factor is whether the tumor can be removed completely by an experienced surgeon. After surgery, an adrenal-specific medicine called mitotane is commonly used to lower the chance of recurrence, and radiation to the tumor bed can further reduce local relapse in higher-risk cases.

How radiation treats it.

Radiation damages the DNA inside cancer cells so they can no longer divide and survive, while normal cells repair themselves more effectively. In adrenocortical carcinoma, surgery and mitotane lead treatment, and radiation plays a focused supporting role: targeting the tumor bed after surgery to lower the chance of local return, and precisely controlling isolated areas of spread. Modern techniques shape the beam to the target and spare nearby organs such as the kidney, liver, and bowel. Radiation is delivered as short, painless daily sessions and leaves no radioactivity in your body.

The ways we can treat it.

Radiation to the tumor bed (adjuvant). After surgery, targeted radiation to where the tumor was can reduce the chance of local recurrence, especially for large tumors, close or positive margins, or when the tumor was disrupted during removal.

Stereotactic body radiation (SBRT). Precise, high-dose radiation can control isolated areas of spread — for example to bone, lung, or liver — when the goal is durable control of a limited number of sites.

Palliative radiation. Short courses of radiation effectively relieve pain from bone metastases and other symptoms in advanced disease.

Questions we hear often.

Why is surgery by a specialist so important? Adrenocortical carcinoma is best controlled when the entire tumor is removed in one piece with clear margins. Experienced, high-volume adrenal surgeons are more likely to achieve a complete removal without rupturing the tumor, which strongly improves the chance of cure.

What is mitotane and why might I take it? Mitotane is a medicine that specifically acts on adrenal cortex cells. It is often given after surgery to lower the risk of the cancer coming back, and it is used for advanced disease. Because it affects hormone production, your team will monitor blood levels and provide hormone replacement as needed.

Does this cancer cause hormone symptoms? Often yes. Many adrenocortical carcinomas make excess hormones, which can cause weight gain, high blood pressure, high blood sugar, easy bruising, or other hormonal changes. Controlling these hormones is an important part of treatment and comfort.

This guide is informational only. It is not medical advice — please confirm anything here with your care team.