The short answer
Surgery to remove the adrenal gland is a main option when the tumor can be removed. Other care may include mitotane, chemotherapy, radiation, symptom treatment, or a clinical trial depending on stage and recurrence. The most useful conversation starts with the goal of treatment and the exact disease features driving the recommendation.
Ask the team to name the goal of treatment.
Understand which diagnosis details drive the recommendation.
Ask about benefits, risks, sequence, and alternatives.
Rare-cancer expertise and clinical trials may be worth discussing.
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This page is for people with adrenocortical carcinoma, and their families, who are getting ready to talk about treatment. It explains the main choices and their side effects. It also covers the signs that cannot wait, and questions to ask.
The short answer
Adrenocortical carcinoma is a rare cancer. It grows in the outer layer of the adrenal gland. Your adrenal glands sit above your kidneys. They make hormones (chemical messengers) your body needs. Treatment is mainly surgery when it can be done. A drug called mitotane is often added. Radiation and chemo are also used. How they are combined depends on your case.
Surgery: the main treatment
Surgery to take out the adrenal gland is called adrenalectomy. It is the main treatment when all of the cancer can be taken out. Your surgeon may also take out nearby lymph nodes or tissue if the cancer has spread there. Lymph nodes are small, bean-shaped parts of the immune system. Ask your surgeon straight out if they think all of the cancer can be taken out. The answer shapes the rest of your plan and what to expect.
Mitotane: a drug specific to this cancer
Mitotane is the main drug used for adrenocortical carcinoma. It blocks hormone production by the adrenal gland. It also destroys both cancer cells and healthy adrenal cells. It may be used after surgery to lower the chance the cancer returns. It can also be a primary treatment for cancer that cannot be fully removed. Mitotane affects your healthy adrenal tissue too. Because of this, it commonly causes low cortisol. You will likely need steroid hormone replacement pills. It can also affect thyroid hormone and testosterone levels. Ask your team what hormone monitoring and replacement plan goes along with this drug.
Other side effects of mitotane
Beyond hormone effects, mitotane commonly causes abdominal discomfort, nausea, vomiting, and diarrhea. It can also cause depression, dizziness, rash, and high cholesterol. This drug requires close medical supervision. The FDA label says blood levels of the drug are checked regularly. Getting the dose right matters for how well the drug works and how well side effects are managed. Report new depression or mood changes to your team. These are real, treatable side effects. Do not push through them alone.
Chemotherapy and its side effects
When chemo is used, it is often given with mitotane. Common chemo drugs for this cancer include carboplatin, cisplatin, etoposide, and doxorubicin. Common side effects include:
- nausea, vomiting, and appetite loss
- hair loss and mouth sores
- lower blood counts, which raise the risk of infection and bleeding
- diarrhea
- nerve problems with cisplatin, like pain, burning or tingling in your hands or feet
Radiation therapy
Radiation therapy uses strong beams of energy to kill cancer cells. It can come from a machine outside your body. It can also come from inside, using radioactive material placed near the tumor. How it is used depends on the type and stage of your cancer.
Newer options being studied
Two newer kinds of drugs are being tested in clinical trials (research studies in people) for this cancer. Immunotherapy helps your immune system fight cancer. Targeted therapy attacks certain features of cancer cells. These are not yet standard treatments. Ask your team if a clinical trial might make sense for you.
Which symptoms cannot wait
A fever of 100.4°F (38°C) or higher during chemotherapy is an emergency, not a same-day call. CDC says fever during chemotherapy is a medical emergency, and to call your doctor immediately at that temperature. Fever may be the only sign of an infection, and infection during chemotherapy can be life-threatening. Follow your team's emergency plan, and go to the emergency department if you cannot reach them.
Severe weakness, confusion, repeated vomiting, or dizziness could signal an adrenal crisis (cortisol far too low). MedlinePlus says to go to the emergency room or call 911 for these signs. The mitotane label warns that adrenal crisis can happen with infection or injury and can lead to death. Call your doctor right away if you are injured, get an infection, or become ill. Do not wait and see.
What to ask your care team
- Can my cancer be fully removed with surgery?
- Will I be on mitotane, and what hormone replacement or monitoring goes along with it?
- What side effects should I expect from my mix of treatments?
- Is a clinical trial a good option for me?
Sources
Common questions
What treatments might be discussed?
Surgery to remove the adrenal gland is a main option when the tumor can be removed. Other care may include mitotane, chemotherapy, radiation, symptom treatment, or a clinical trial depending on stage and recurrence.
Why can plans differ?
Plans can differ because adrenocortical carcinoma may vary by subtype, extent, symptoms, test results, and the person's overall health and goals.
Should I ask about a clinical trial?
Yes. Asking does not commit you to join. The team can explain whether a study fits the diagnosis, timing, location, and goals.
What should I know before agreeing?
Ask about the goal, likely benefits, important risks, alternatives, schedule, monitoring, practical costs, and what happens if the treatment does not work or is hard to tolerate.
Questions to ask your doctor
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Get urgent help
Fever of 100.4°F (38°C) or higher during chemo, severe pain, or trouble breathing: call your cancer care team right away, day or night. Call 911 for an emergency.
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Sources last checked: 2026-08-13 what this meansLast updated: 2026-09-29Next planned review: 2027-01-22
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Cancer Explained does not originate medical claims. Every page restates guidance already published by the National Cancer Institute, the CDC, the USPSTF and the FDA, in plain language, with the source cited so you can check the original yourself. AI does the translating and organizing; automated checks test claims, citations, clarity and safety before anything publishes, and this is translation and navigation, not clinical judgment. Nothing here is personal medical advice, and no page can account for your particular situation.
Editorial status: Source checked — This page was written with AI assistance and then compared with the sources listed on it, looking for statements those sources do not back up. That check is not a sentence-by-sentence record and can miss errors. It is not a medical review, and it does not confirm the page is complete or right for your situation.
Human medical review: not completed. Pages here are not signed off by a clinician before they publish. That is not an oversight we are quietly working around: we restate published guidance and cite it, so the authority belongs to the source rather than to us, and every page names where its claims come from — you can verify us instead of trusting us. Where a volunteer clinician has reviewed a page, their name and credentials appear on it; where no name appears, no clinician has checked it. We are glad to have reviewers and are recruiting them, and we do not hold pages back waiting for one. Use this site to understand your situation and to ask better questions of the people treating you.
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