THE ACCIDENTAL TUMOR
When patients hear the word “tumor,” it usually causes some apprehension. While “tumor” is a term used to describe any abnormal growth of cells that forms a mass in the body, not all tumors are cancerous.
Tumors can grow from any cell in the body and, depending on the type of cell, they may either be benign or noncancerous, precancerous or cancerous, which are malignant tumors.
Many benign tumors are called adenomas, from the Greek aden, meaning “gland” and oma denoting the tumor or abnormal growth. Some tumors are visible if they are just under the skin like lipomas which are benign tumors made up of fatty tissue or in the front of the neck like a goiter which can be a thyroid adenoma.
But some tumors are only found by accident when tests are done to look at something else. Since the tumor is an unexpected finding and not related to why the test was done in the first place, it is called an incidental tumor or an “incidentaloma.”
One of the more common incidentalomas is the adrenal incidentaloma. There are two adrenal glands, one found on top of each kidney, thus they are sometimes called the suprarenal glands. The adrenals are endocrine organs that produce hormones, such as cortisol, adrenaline and aldosterone, that control many functions in the body.
An adrenal tumor is considered an adrenal incidentaloma when it measures more than one centimeter and is found only by chance when a CT scan or MRI is done to examine the abdominal area for another reason. About one to 10 percent of patients who get these tests done have an adrenal incidentaloma, and it becomes more common with age.
These adrenal tumors are usually benign noncancerous masses that cause no symptoms and don’t require treatment and are called nonfunctioning adrenal adenomas. But sometimes even benign adrenal tumors can secrete hormones and are called functioning adrenal adenomas. About 15 percent of adrenal incidentalomas can produce abnormal levels of hormones. But even with this abnormal secretion of hormones patients may not notice any symptoms if the hormone levels are not too high.
So when an adrenal incidentaloma is discovered, treatment will depend on whether the tumor is functioning or non-functioning. Blood and urine tests are done to check if there is any lack of overproduction of any adrenal hormones. These are interpreted with any other signs or symptoms that the patient may have, such as uncontrolled hypertension, palpitations, sweats and anxiety attacks, to name a few. If it is found that the tumor is functioning, the treatment may include surgery, medication to help control the hormone levels or both.
The size of the tumor is also considered. Those more than four centimeters in size are generally removed surgically because they pose more of a cancer risk. A special CT scan or MRI is also done to look more closely at the appearance of the tumor to determine if it is more likely benign or cancerous.
For non-functioning tumors that appear benign, these should be re-examined with repeat imaging at six to 12 months after the initial discovery, with possible surgical removal if it enlarges by more than one centimeter in diameter. Get regular check-ups and inform your doctor if you develop any symptoms because early detection can help prevent the development of long-term complications.