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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The full explanation.
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 your body depends on. Treatment centers on surgery when possible. A specific drug called mitotane is often added. Radiation and chemotherapy round out the options, in various combinations depending on your situation.
Surgery: the main treatment
Surgery to remove the adrenal gland, called adrenalectomy, is the main treatment when the cancer can be fully removed. Your surgeon may also remove nearby lymph nodes or tissue if the cancer has spread there. Ask your surgeon directly whether they believe the cancer can be completely removed. This shapes the rest of your treatment plan and your expected path forward.
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 affect thyroid hormone too. It can affect testosterone levels as well. 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. This includes regular blood tests to check its levels in your body. Getting the dose right matters. It affects how well the drug works. It also affects 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
When chemotherapy is used, it is often combined with mitotane. Common chemotherapy drugs for this cancer include carboplatin, cisplatin, etoposide, and doxorubicin. These commonly cause nausea, vomiting, appetite loss, hair loss, and mouth sores. They can also lower your blood counts. This raises infection and bleeding risk. Fatigue and anemia are common too. So are nerve-related side effects, like numbness or tingling in your hands or feet.
Radiation therapy
Radiation therapy uses high-energy rays to target cancer cells. It can be external, from a machine outside your body. It can also be internal, using radioactive material placed near the tumor. How it is used depends on your cancer's type and stage.
Newer options being studied
Immunotherapy and targeted therapy are being explored in clinical trials for adrenocortical carcinoma. These are not yet standard treatments. Ask your team whether a clinical trial might be a reasonable option for your specific situation.
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 to call your doctor immediately at that temperature, because fever can be the only warning sign of an infection that turns life-threatening fast. Follow your team's emergency plan, and go to the emergency department if you cannot reach them.
Call your care team the same day, and follow their emergency instructions, for severe weakness, confusion, persistent vomiting, or dizziness. These could signal your cortisol level is too low. They need prompt evaluation, not a wait-and-see approach.
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 specific combination of treatments?
- Is a clinical trial a reasonable option for me?
Sources
Words to know
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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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Sources last checked: 2026-08-13 what this meansLast updated: 2026-08-17Next planned review: 2027-01-22
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How this page was created
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. We do not employ clinicians and do not intend to — our work 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 checked line by line against the sources listed on it. That confirms the sources support what the page says. 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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