Adrenal Cancer: Chemotherapy

Chemotherapy (chemo) uses strong medicines to kill cancer cells. The medicines attack and kill cells that grow quickly, like cancer cells.

But some normal cells also grow quickly. Because of this, chemo can harm those cells. This can cause side effects.

Chemo may be used to treat adrenal cancer that has spread too much to be removed with surgery. In this case, it can’t cure the cancer. But it can help keep it under control.

Chemo might be given after surgery. It's used to kill any cancer cells that weren't removed. This can help prevent or delay the return (recurrence) of the adrenal cancer.

Mitotane is the medicine used most often for adrenal cancer. It stops the adrenal glands from making hormones. It destroys both adrenal cancer cells and healthy adrenal cells.

When you have fewer adrenal hormones, you may feel very tired and weak. If this happens, you'll likely be given steroids to raise your adrenal hormone levels. Mitotane can also change other hormone levels, such as thyroid hormones and testosterone. So you might need to take pills to replace these hormones as well. Medicines to control hormone levels can be used to ease symptoms caused by hormone imbalances. You may need to take them even after treatment is over.

Mitotane works very well when adrenal cancer causes the gland to make too many adrenal hormones. It might not shrink the tumor. But it can help stop more hormones from being made. This can help ease symptoms.

Mitotane is taken 3 to 4 times a day in pill form. You take it at home. Be sure you know exactly how much, when, and how to take it.

Other chemo medicines may be used along with mitotane to treat advanced adrenal cancer. These medicines are given through an IV (intravenous) line into your blood. They include:

• Streptozocin plus mitotane

• A combination of cisplatin, doxorubicin, and etoposide plus mitotane

Other chemotherapy medicines that are used less often for adrenal cancer include:

• Paclitaxel

• 5-fluorouracil (5-FU)

• Vincristine

These medicines are all given by IV. Different combinations of these medicines may be used. They may also be given along with mitotane.

Chemotherapy side effects depend mostly on the type of medicines you are taking. The most common side effects of mitotane include:

• Upset stomach (nausea)

• Vomiting

• Diarrhea

• Rash or changes in skin color (skin may get darker)

• Decreased appetite

• Depression

• Dizziness

• Sleepiness

You will be watched closely while taking mitotane. Tell your treatment team about any changes you notice.

Other chemo medicines can affect your blood cells counts. For instance, you may have a higher risk of infection if chemo causes a drop in your white blood cell counts. If you have any symptoms of infection during chemo, tell your healthcare team right away. Let them know if you have a fever.

If your blood-clotting cell (platelet) counts are down, you may bruise and bleed more easily from a cut or injury. You may feel more tired if you have a low red blood cell count.

Most side effects go away over time when treatment is stopped. There are medicines that can help reduce and even prevent some side effects. They can help you recover from chemo more quickly.

It's important to know which medicines you're taking. Write down the names of the medicines. Ask your healthcare team how they work, what they're for, and what side effects they might cause.

Talk with your healthcare providers about what signs to look for and when to call them. Make sure you know what number to call if you have questions. Is there a different number for evenings and weekends?

It may be helpful to keep a diary of your side effects. Write down physical, thinking, and emotional changes. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage any side effects.