How is adrenal cancer diagnosed?

If your healthcare provider thinks you might have adrenal cancer, certain exams and tests will be done to be sure. Diagnosing adrenal cancer starts with your healthcare provider asking you questions. You'll be asked about your health history, your symptoms, risk factors, and family history of disease. A physical exam will be done.

What tests might I need?

You may have 1 or more of these tests:

• Blood tests

• Urine tests

• Chest X-ray

• Ultrasound

• CT scan

• MRI scan

• PET scan

• MIBG, a nuclear scan

• Biopsy

Blood and urine tests

Blood and urine hormone tests measure the amount of adrenal hormones in your blood and urine. A 24-hour urine test may also be done. To do this, you save your urine in a special container for 24 hours. It's then sent to a lab to check the amounts of certain hormones. All of these tests can be very helpful in figuring out what kind of cancer you have.

Activating and inhibitory tests might be done. To do these, you're given medicines to increase or decrease certain adrenal hormones. Blood or urine tests will then show if the hormone levels changed. Hormones made by a cancer tumor often don't change with these medicines.

Imaging tests

• Chest X-ray. This can be done to see if the cancer has spread to your lungs. It can also show if you have any lung or heart problems.

• Ultrasound. This test uses sound waves and a computer to make pictures of the inside of your body. This test may be used to look for a tumor in the adrenal gland. It can show if the tumor is a fluid-filled sac (cyst), which is likely not cancer. It can also show if a tumor is solid, which is more likely to be cancer. Ultrasound can be used check the liver for tumors, too.

• CT scan. A CT scan uses a series of X-rays and a computer to make detailed images of the inside of the body. CT scans can be used to measure the tumor and find out exactly where it is. A CT scan can also show if the cancer has spread.

• MRI. An MRI uses magnets and radio waves to take pictures of the inside of the body. It doesn't use X-rays. MRIs can be used to check the brain and spine for problems. They can sometimes help find out if an adrenal tumor is or isn't cancer.

• PET scan. For these tests, a mildly radioactive substance, like sugar, is injected into your blood. It then travels all over your body. The substance is more likely to collect in cancer cells or in different types of adrenal tumors. The radiation can then be found with a special camera to show where the tumors are.

• MIBG scan. MIBG is a chemical injected into the vein that is similar to adrenaline that will collect in a neuroendocrine tumor. This type of nuclear scan may show an adrenal tumor that may not show up on X-ray. Scans are taken over 2 consecutive days once the injection is given.

Biopsy

If your healthcare provider finds something in another part of your body that may have spread there from adrenal cancer, a biopsy may be done. This is the best way to know for sure that a change is cancer. A tiny piece (called a sample) of the tumor is taken out using a thin needle. A CT scan might be used to guide the needle into the tumor. The sample is then tested by a pathologist. This is a doctor who specializes in looking for disease. The pathologist looks at the cells to see if cancer is present.

Getting your test results

Your healthcare provider will contact you with your test results. Your provider will talk with you about other tests you may need if adrenal cancer is found. Make sure you understand the results and what your next steps should be.