The first step in diagnosis is usually a physical exam and medical history. Your doctor will check your body for signs of disease. He or she will want to know whether your family has a history of adrenal cancer. You will be asked about your sexual function and menstrual periods (if you are female).
A number of different tests and procedures may help diagnose adrenocortical carcinoma. They vary depending on the person's symptoms. You may have one or more of the following tests:
Blood and urine tests. Your blood and urine are analyzed to look for abnormal levels of hormones and other substances.
Imaging tests: Several types of imaging tests look inside the body for adrenocortical carcinoma. They can also help determine whether the cancer has spread to other parts of the body.
Adrenal angiography and venography: These tests show the arteries or veins and blood flow near the adrenal gland.
Biopsy: A needle is used to remove a piece of tumor that will be examined in a laboratory. The results can show where an adrenal gland tumor started. A biopsy can also confirm whether the cancer has spread.
If adrenocortical carcinoma is diagnosed, your care team will need to find out if the cancer cells have spread within or beyond the adrenal gland. This is called staging. Staging is important for planning treatment and assessing your prognosis. Many of the tests used for diagnosis also help doctors determine the stage of the cancer.
The four stages of adrenocortical carcinoma are defined by the size of the tumor and how far the cancer has spread:
Stage I: The tumor is 5 centimeters or smaller and is confined to the adrenal gland.
Stage II: The tumor is more than 5 centimeters and is found only in the adrenal gland.
Stage III: The tumor may be any size and may have spread to nearby tissues or lymph nodes.
Stage IV: The tumor is any size and has spread to nearby or distant sites.
Cancer that has returned after it has been treated is called recurrent adrenocortical carcinoma.