When lung cancer spreads to the adrenal glands, it is known as an adrenal metastasis. It is fairly common, with about 42% of lung cancers leading to this type of metastasis.

While most individuals don’t experience any symptoms when cancer spreads to the adrenal glands, some are possible, such as back or abdominal pain. A computed tomography (CT) scan and a biopsy may be ordered to diagnose the condition.

Treatment will vary but may include surgery, medication, chemotherapy, and radiation. An adrenal metastasis has a better prognosis than other sites of metastases, especially if it occurs on the same side of the body as the primary or original tumor.

This article discusses adrenal metastasis and lung cancer. It explains how common this condition is, how it is diagnosed, and the associated symptoms. It also covers treatment options and prognosis.

Prevalence of Lung Cancer With Adrenal Metastasis

The adrenal glands are small, triangular-shaped glands that are located on the top of each kidney. These endocrine glands are responsible for secreting hormones, including “stress hormones” such as cortisol, epinephrine (adrenaline), and norepinephrine. 

Nearly any cancer can spread to the adrenal glands, but some tumors are more likely than others to metastasize to this region.

Other common cancers that spread to this region include kidney cancer, melanoma, breast cancer, colon cancer, and lymphoma.

According to a study published in the Journal of Thoracic Oncology, the cancers most responsible for adrenal metastases are lung cancer (35%), stomach cancer (14%), esophageal cancer (12%), and liver cancer (10%).

Up to 40% of people with lung cancer will develop adrenal metastases at some time, and in 10% of people with non-small cell lung cancer, the disease spreads to both adrenal glands.

These metastases are present in 2% to 3% of people at the time of diagnosis, and on rare occasions are the first sign of lung cancer.

Symptoms of Adrenal Metastasis

Most of the time when cancer spreads to the adrenal glands there aren’t any symptoms. In fact, in one study only 5% of people with adrenal metastases had symptoms.

People are most often only aware of these metastases due to radiology studies such as a CT scan, MRI, or PET scan.

When symptoms are present, they may include:

  • Back pain (in the mid-back region)Abdominal painBleeding into the abdomen (hemorrhage)

It can also cause adrenal insufficiency also known as Addison’s disease. Symptoms of Addison’s disease include:

  • Weakness
  • Low blood pressure (hypotension)
  • Low blood sugar (hypoglycemia)
  • Low sodium level in the blood (hyponatremia)
  • High potassium level (hyperkalemia)

Addison’s disease develops in rare cases when both adrenals are significantly involved by malignancy.

Diagnosis

If you have a scan suspicious for adrenal metastases, you won’t necessarily need any further evaluation, especially if you have metastases to other regions of your body.

In some cases, your healthcare provider may wish to be certain that a mass in your adrenal gland is due to metastatic cancer and recommend a CT-guided biopsy.

Treatment for Lung Cancer That Has Spread to the Adrenal Glands

The treatment recommended for adrenal metastases can vary depending on several factors. For all people, supportive care is important.

If lung cancer metastasizes, it is considered stage 4. While healthcare providers could do little about this in the past, aggressive surgical treatment paired with newer drug therapies has improved survival rates in people with isolated adrenal metastasis.

In people with symptoms such as hemorrhage, treatments such as surgery may be necessary to control symptoms. In some people, treatment with the goal of curing cancer may be a possibility.

Supportive Care

Whether or not you and your healthcare provider decide upon further treatment of your cancer or your adrenal metastases, caring for your symptoms remains paramount.

People with cancer deserve good pain management and control of other symptoms related to cancer.

Treatment of Symptoms

Adrenal metastases rarely cause symptoms. If a metastasis is bleeding (hemorrhaging) or is at high risk of bleeding, surgery to remove the tumor and adrenal gland (adrenalectomy) may be recommended.

If the metastasis has resulted in adrenal insufficiency, treatment with steroids may be needed. If back pain or abdominal pain occurs, this should be treated.

Treatment of the Primary Tumor

Treating stage 4 lung cancer may include chemotherapy, targeted therapies, immunotherapy, and/or radiation therapy. Some people also participate in clinical trials studying new drugs and procedures.

The addition of targeted therapies and immunotherapy have changed the face of advanced lung cancer for many people in recent years.

An example is ALK-positive lung cancer. A 2018 study found that, with appropriate treatment, the median survival of people with stage 4 disease was 6.8 years, even if they had brain metastases.

If targetable mutations are present, targeted drugs can sometimes treat stage 4 lung cancer like a chronic disease. While drug resistance remains a concern, second- and third-line drugs are now available to extend the duration of therapy.

Immunotherapy, when effective, has sometimes even resulted in a “durable response,” holding lung cancer in check for a lengthy period of time. Since the first drug in this category was only approved in 2015, we have yet to know if the remissions we sometimes see will last, or what the long-term outcomes may be.

Treatment With a Curative Intent

For people with an isolated adrenal metastasis, treatment may potentially result in long-term survival. Options include:

  • Surgery: Both open and laparoscopic adrenalectomy (removal of an adrenal gland) may be done with a curative intent for some people.
  • Stereotactic body radiotherapy (SBRT): If surgery isn’t possible, studies suggest that SBRT may be effective and well tolerated. SBRT involves using a high dose of radiation to a small area and sometimes has results similar to surgery. In a 2018 study, local treatment of lung cancer adrenal metastases with SBRT resulted in overall survival rates at 6 months, 1 year, and 2 years of 85.8%, 58.1%, and 54%.
  • Ablation: Image-guided percutaneous ablation is yet another option. A 2018 study found that, although survival was poorer for those with non-small cell lung cancer who underwent the procedure than with some other cancers, image-guided percutaneous ablation of adrenal metastases may extend local progression-free survival as well as overall survival. In the study, the average overall survival (for all tumor types combined) at 1, 3, and 5 years was 82%, 44%, and 34% following the procedure.

Prognosis

Without treatment, the median survival following a diagnosis of adrenal metastases depends on the type of malignancy and the presence and location of other metastases.

With that said, recent studies evaluating the aggressive surgical treatment of adrenal metastases have been encouraging. In addition, studies done in the past do not reflect the many new treatments for lung cancer that have been approved in just the past few years.

The researchers further reported that people with contralateral adrenal metastasis (cancer occurring on the opposite side of the body) had a five-year survival of zero.

A study published in the Annals of Thoracic Surgery reported a 5-year survival rate of 83% in people who had undergone the simultaneous removal of a primary lung tumor alongside an adrenal metastasis occurring on the same side of the body.

Why Prognoses Vary

The answer to why certain adrenal metastases have a better prognosis may be in how cancer spreads through the body. Broadly speaking, cancer spreads in three distinct ways:

  • As a tumor invades nearby tissueAs cancer cells break off and travel through the lymphatic systemAs cancer cells break off and travel through the bloodstream

Ipsilateral (same-sided) adrenal metastases are believed to be associated with the lymphatic system, while contralateral (opposite-sided) adrenal metastases are believed related to the bloodstream.

By contrast, when cancer cells enter the bloodstream, they circulate again and again throughout the body without stopgaps. Doing so typically results in more widespread disease as multiple organs are exposed to the circulating cancer cells.

When cancer cells spread through the lymphatic system, they are stopped along the route by lymph nodes that filter lymph fluid. Because of this, cancer is more likely to reach the adrenal gland in a direct path, typically on the same side of the body.

Contralateral adrenal metastasis is more likely to occur via the bloodstream, given that this is the most obvious path between a primary lung tumor and a contralateral adrenal gland.

Coping

The prognosis with metastatic lung cancer is not what we would wish. That said, of all sites of metastases, adrenal metastases often have a better prognosis (and as noted, the prognosis is even better if the involved adrenal gland is on the same side of the body as the lung cancer).

In addition, the treatment options and survival rates for advanced lung cancer are slowly improving, especially when targeted therapies for genetic mutations or immunotherapy drugs can be used to treat the tumor.

If you’ve been diagnosed with stage 4 lung cancer and adrenal metastases, take time to learn about your cancer. Participating in the lung cancer community online is very helpful.

Newer treatments are improving survival rates, but the treatment of lung cancer is changing so rapidly that is hard for anyone to stay on top of the latest findings.

You may also wish to consider a second opinion at one of the larger National Cancer Institute-designated cancer centers, where oncologists who specialize in lung cancer have access to the latest research and clinical trials available.

If you want to keep abreast of cutting-edge research, the hashtag #lcsm can help plug you into the lung cancer social media stream.

A Word From Verywell

Whatever the stage of your cancer, take an active part in your care and be your own advocate. Self-advocacy not only reduces anxiety and helps you feel more in control of your disease but may improve outcomes as well.

Keep in mind that the local treatment of “oligometastases” (a term used to describe a situation in which only a few metastases are present) is very new, and, despite encouraging studies, not all healthcare providers have had the opportunity to experience these treatments with their patients, or the potential benefits.

Lung cancer treatment is changing so rapidly that it is challenging even for lung cancer specialists to keep up with all of the changes, in addition to changes that are occurring across disciplines such as oncology, thoracic surgery, and radiation oncology.