Managing Bilateral Adrenal Tumors: Insights After Ovarian Cancer Treatment

Q: Managing Bilateral Adrenal Tumors: Insights After Ovarian Cancer Treatment

Hello： Some adrenal tumors are benign and do not require surgery; they only need regular blood tests, imaging assessments, and follow-up with a specialist. <br>Wishing you good health.

Bilateral adrenal tumors measuring 5 centimeters each?

Dear Doctor,
My wife was diagnosed with stage 3c ovarian cancer over a year ago, with a tumor measuring 15 centimeters.
A pre-operative CT scan also revealed a 5-centimeter tumor on each adrenal gland.
However, the focus of the treatment was on the ovarian cancer, and no further evaluation of the adrenal tumors was conducted at that time.
After completing chemotherapy more than a year later, we performed a full-body CT scan to check for any signs of metastasis, during which we finally paid attention to the adrenal tumors.
She was subsequently hospitalized for detailed examinations.

Comparative CT scans showed that the adrenal tumors had not increased in size, and my wife has not experienced any symptoms.
The endocrinologist suggested that if future reports indicate that the tumors are benign and non-functional, it would be advisable to coexist with the tumors and continue monitoring them, rather than opting for surgery.

I would like to hear your perspective on this matter or if you could provide us with additional options to consider.
Thank you.

Mr. Wu, 40~49 year old female. Ask Date: 2023/04/15

Dr. Du Shixi reply Urology

Hello: Some adrenal tumors are benign and do not require surgery; they only need regular blood tests, imaging assessments, and follow-up with a specialist.
Wishing you good health.

Reply Date: 2023/04/15

More Info

Managing bilateral adrenal tumors, especially in the context of a history of ovarian cancer, requires a careful and nuanced approach. Your wife's case presents several important considerations that need to be addressed.

Firstly, it is essential to understand the nature of the adrenal tumors. Adrenal tumors can be classified as functional or non-functional. Functional tumors produce hormones that can lead to various clinical symptoms, while non-functional tumors do not produce hormones and may be asymptomatic. Given that your wife's adrenal tumors were discovered incidentally during imaging for ovarian cancer and have not shown any growth or caused symptoms, they may likely be non-functional. The fact that they have remained stable over time is a positive sign.

In cases where adrenal tumors are found incidentally and are non-functional, the current medical consensus often leans towards a conservative management approach. This typically involves regular monitoring through imaging studies and clinical evaluations rather than immediate surgical intervention. The rationale behind this is that many adrenal tumors, particularly those that are small and non-functional, are benign and do not require surgical removal. The recommendation from the endocrinologist to "live in harmony" with the tumors, as long as they remain stable and asymptomatic, is a common practice in such scenarios.

However, it is crucial to ensure that the tumors are indeed benign. This may involve further testing, such as biochemical tests to assess for hormonal activity (e.g., measuring cortisol, aldosterone, and catecholamines) and possibly a biopsy if there is any suspicion of malignancy. If the tumors are confirmed to be non-functional and benign, the approach of continued surveillance is appropriate.

On the other hand, if there are any changes in the size of the tumors, the appearance on imaging, or the development of symptoms, further evaluation would be warranted. Surgical intervention may be considered if there is a significant increase in size, if the tumors become functional, or if there is any suspicion of malignancy based on imaging or clinical findings.

In terms of options, if your wife is concerned about the adrenal tumors, it may be beneficial to seek a second opinion from a specialist in adrenal disorders or an oncologist with experience in managing adrenal tumors. They can provide additional insights and may suggest alternative monitoring strategies or interventions based on the latest research and clinical guidelines.

In conclusion, the management of bilateral adrenal tumors in the context of a history of ovarian cancer should be individualized based on the characteristics of the tumors, the patient's overall health, and any symptoms present. Regular follow-up and imaging are essential to ensure that any changes are promptly addressed. Open communication with healthcare providers and seeking second opinions can empower you and your wife to make informed decisions regarding her health.

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