Since the adrenal or
parathyroid cancer is a clinically rare entity. We often have difficulty in its diagnosis and treatment. The
adrenocortical cancer is usually classified into two categories--endocrinologically functioning or non-functioning. The incidence is not different between them. It is often found in an advanced stage as it does not show clinical manifestation before it has grown up to a large
tumor. Only an effective agent for the
adrenal cancer is op'-
DDD so far. Recently,
cisplatin,
VP-16 (
etoposide) and others are administered as trial use. Most of malignant
pheochromocytomas are endocrinologically active and they often cause
hypertension leading to death. Therefore it is important to control
hypertension in malignant
pheochromocytoma.
Chemotherapy and irradiation are not effective for it. Recently, 131I-MIBG (metaiodobenzylguanidine) is found to be useful not only for diagnosis but also treatment of malignant
pheochromocytoma. 131I-MIBG is accumulated specifically in the chromaffin cells and with helpful to find out metastatic foci. It is also used in a large amount as a specific irradiation
therapy for this
malignancy.
Parathyroid cancer is found in approximately 3 percent of
primary hyperparathyroidism. Clinically it usually reveal serum
calcium level higher than 14 mg/dl, bone lesions and renal dysfunction in addition to palpable cervical
tumors adhering with skin. Sometimes it is difficult to differentiate
malignancy from
adenoma in histology. Most cases develop local recurrences and distant
metastases in due course and dies of
hypercalcemia. It is very important to control
hypercalcemia in inoperable cases. As both
chemotherapy and
radiation therapy render no effect on this
malignancy. Surgery is a sole strategy for it.