Lung Cancer Metastasis to Adrenal Gland

[Anthony590]

In January 2008, I was diagnosed with a primary lung carcinoma.   In February 2008, I underwent surgery (Video Assisted Thoracic Surgery) and they removed an adenocarcinoma 1.8 x 1.6 cm.   I took a CT Chest Scan (3) three months postoperative and nothing showed up.   I took a CT Chest Scan (6) six month postoperative and a NEW right adrenal mass - 3.2 x 2.0 - appeared that is being described as "suspicious for metastatic disease".   This is a rare cancer especially in metastatic form.    What tests should I take to determine if it is benign or malignant?   I was referred by the lung surgeon for a PET/CT.    Is this the right test?   I sought a second opinion from a doctor who specializes in this disease in all of New York City and he ordered a 24 hours blood and urine test.     Can a biopsy be performed?    What are the best known diagnostic tools out there.    Otherwise, they are telling me about laproscopic surgery to remove the right adreanl gland.     What should I do?

[ray419]

why does lung cancer have a propensity to metastasize

[vetboy2091]

My 71yo mother was diagnosed with Adenocarcinoma in her Right lung.  With many Radiation therapies and three chemos, we eventually were able to have an RFA procedure.  Post procedure the doctor stated that there was no real word to describe lung cancer that is in remission but said if he had to call it something he said it would be  remission.  Three months later, after PET, the cancer has gone into one adrenal gland, three mediastinal lymph nodes and "an area of possible activity" in her scapula.  She has recently had a second port put in for another round of chemo that is "much more tolerated" and wont make her sick or lose her hair.  The doctor has asked for a brain scan which freaked my mom out but he said it was "very routine" does this mean he thinks it has gone to her brain? or is it in fact routine.  She had a primary brain scan when this first came up.  I guess my questions are, does anyone know what this new tolerated chemo is? ( I could have asked but he s tired of me asking questions) is an adrenalectomy something that she should consider? and after the mediastinal lymph node activity is gone, should another RFA procedure be done?.  Thanks so much

[HeinrikMD]

Hi,

Performing a biopsy would depend on the size and the history of cancer. If there is a history of cancer and there is a chance for cure then a biopsy is usually warranted if any non-invasive tests (like the CT, the PET scan) cannot rule out cancer.  A needle biopsy would be appropriate, this is usually done with an imaging tool for guidance.
Blood tests and urine tests look for signs of hormonal excess (as the adrenal mostly produces hormones), this will have an impact of whether the mass is a new primary or not and on management if removal of the mass is deemed appropriate.  

[Anthony590]

Thank you for responding to my inquiry.   What kind of biopsy is needed?   The NEW
adrenal mass may be metastatic or a NEW primary carcinoma.   Is it a fine needle aspiration?    Do 24 hour blood and urine tests determine anything important?  
Staying Positive.    Anthony590

[HeinrikMD]

Hi,

Adenocarcinoma of the lung (compared with other subtypes of lung cancer) has a propensity to metastasize. You may have some information mixed up. Primary cancer on the adrenal gland is rare. Metastasis from lung cancer to the adrenal gland is common. Since you report this as NEW, then an appraisal whether it is metastatic indeed would be important.
A PET scan is used to check its metabolic activity, so this would constitute a reasonable step to take.
If the PET does not eliminate the suspicion of cancer, then a biopsy and possibly an excision would be the next best step to take.
Stay positive.