Pheochromocytoma & Paraganglioma, from the CureRays guide library.

Pheochromocytoma and paraganglioma are rare tumors that can release adrenaline-like hormones; surgery is the main treatment, and special targeted radiation can control tumors that have spread.

What it is.

Pheochromocytoma and paraganglioma are rare tumors that grow from the same special nerve-related cells that make adrenaline and similar 'fight-or-flight' hormones. When the tumor starts in the inner part of an adrenal gland (the gland sitting on top of each kidney), it is called a pheochromocytoma. When it starts in similar cells found elsewhere along the spine, in the chest, abdomen, or pelvis, it is called a paraganglioma. Many of these tumors are 'functioning,' meaning they pour extra adrenaline-type hormones into the blood. That can cause spells of pounding heartbeat, high blood pressure, sweating, headache, and anxiety. Because of these hormone surges, the care team takes special steps with medicines before any procedure to keep blood pressure safe. A good share of these tumors run in families or are linked to inherited gene changes, so genetic counseling is often offered. Most are slow-growing and curable with surgery, but some can spread, and those cases are managed by an experienced team using surgery, special targeted radiation, and medicine.

How radiation treats it.

Radiation treats these tumors in two ways. The first is from the outside, using focused high-energy x-rays aimed precisely at a tumor to damage its DNA so the cells can no longer grow — useful for controlling or relieving specific spots such as in bone or the spine. The second, and often more important here, is radiation delivered from the inside. Because pheochromocytomas and paragangliomas absorb certain molecules, doctors can attach a radioactive tag to one of those molecules and give it through a vein. It then travels through the bloodstream and concentrates inside tumor cells wherever they are, irradiating them from within while largely sparing healthy tissue. This is called radiopharmaceutical therapy or theranostics. Treatments are planned by a specialized team, and because these tumors can release hormones, blood pressure is managed carefully throughout. Side effects are usually manageable and depend on the approach used.

The ways we can treat it.

Radiopharmaceutical therapy (I-131 MIBG). A radioactive form of a molecule these tumors absorb is given through a vein; it travels to tumor cells anywhere in the body and delivers radiation from the inside.

Peptide receptor radionuclide therapy (PRRT). For tumors with the right surface markers, a radioactive medicine binds to the tumor cells and irradiates them directly, sparing most normal tissue.

Stereotactic body radiation (SBRT). Highly focused external radiation in a few sessions can control a limited number of metastatic spots, such as in bone or the spine, while protecting nearby organs.

Palliative external radiation. Precise radiation aimed at painful deposits relieves symptoms and improves comfort.

Questions we hear often.

Why do I need medicine before surgery? These tumors can release surges of adrenaline-like hormones that spike blood pressure during a procedure. Taking blood-pressure medicines (alpha blockers) for a few weeks beforehand makes surgery much safer. Your team will guide the timing carefully.

Should my family be tested? Often, yes. A meaningful share of these tumors are linked to inherited gene changes. Genetic counseling and testing can show whether relatives should be screened and can guide your own follow-up. Your team can arrange this.

What if the tumor has spread? Spread disease is managed by an experienced team. Options include special radioactive medicines that target tumor cells throughout the body, focused external radiation for specific spots, surgery when helpful, and medicines to control hormones and growth.

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