In my 83-year-old grandmother, with pains in the right upper abdomen, a tumor of the right adrenal gland, 8 cm in size, was detected. The tumor does not release hormones, has no infiltrates, and the lesion is considered to be benign, with no signs of malignancy. I am aware that the tumor is very large, but I hesitate to make a decision whether to operate or not. Looking at my grandmother's age and coexisting diseases: long-term obstructive pulmonary disease, emphysema, respiratory failure, arterial hypertension, degenerative changes in the spine along its entire length and many others - I have concerns whether deciding on this procedure will not worsen her he alth. I consulted an oncologist, urologist, internist and each of them confirmed my fears. However, the surgeon says it should be operated on, but does not guarantee that the pain will stop after the operation, as the cause of the pain is unknown. Doctor, what to do?
Hello, the problem you are asking about is actually very difficult to solve, because each of the choices can be equally favorable and unfavorable. From a purely formal point of view, a tumor larger than 3-4 cm in diameter may suggest that it is a malignant tumor and should be removed as such. On the other hand, the lack of other evidence in the patient's tests showing the malignancy of the tumor (metastases, uneven outline, enlarged lymph nodes, hormonal activity) weakens this suspicion. Sometimes, several months of observation of the patient, in particular monitoring the size of the tumor by performing imaging tests, are helpful in making the final decision regarding the operation. If the tumor dimensions increase during observation, this indicates the need for surgery. The tumor enlargement by 1 cm in a year is considered an indication for surgery and suggests its malignant nature. Although the cause of epigastric pain has not been established, it should be taken into account that it may be related to the existence of a tumor in the right adrenal gland. Pain may be related to pressure symptoms that arise in the presence of such a tumor. The comorbidities mentioned by you are of course a significant threat in the perioperative period. In the case of operations on smaller adrenal tumors, laparoscopic operations and the postoperative period are performedwith this technique it is usually better tolerated by patients than with traditional surgical procedures. In the case of a larger tumor, one must take into account that there may be a need for traditional surgery, which will increase the risk of comorbidities getting worse. Finally, a very important moment in the assessment of indications for surgical treatment in cases where these indications are not easy to define unequivocally is the fact whether this assessment is given by the surgeon who will operate or by the person who assesses the case, as it were, theoretically. The experience of the surgical center in performing procedures is also important. Surgery to remove an 8-centimeter adrenal tumor in a 83-year-old patient with concomitant diseases in the form of many years of obstructive pulmonary disease, emphysema, respiratory failure, arterial hypertension (you do not mention the high blood pressure values, it can also be very important!) performed in a center with extensive experience in carrying out such operations. In view of such difficult decision-making circumstances, perhaps it is worth taking advantage of the so-called a second opinion, i.e. consulting the patient in another center. When choosing a center for such consultation, it is very important that this center has adequate experience in the surgical treatment of adrenal tumors. Regards, dr n.med. Krystyna Knypl
Remember that our expert's answer is informative and will not replace a visit to the doctor.
Krystyna KnyplInternist, hypertensiologist, editor-in-chief of "Gazeta dla Lekarzy".
More advice from this expert
Candida albicans yeast allergy [Expert's tip]Painful bursting blood vessels in the knee area [Expert's advice]Shortness of breath, pressure and pain in the heart area [Expert Advice]I still have a cold - what should I do? [Expert advice]Pressure in a teenager [Expert Advice]What will help me with heartburn? [Expert advice]Can emotions and character affect pressure spikes? [Expert advice]Is mold in pasta harmful to a child? [Expert advice]Can poor kidney function cause calf swelling? [Expert advice]What is the difference between myocarditis and myocardial infarction? [Expert advice]My blood pressure rises a lot - how can I control it? [Expert advice]HIV diagnosis [Expert Advice]WFD doubled - morphology [Expert's advice]My stomach teases when I stop taking medications [Expert advice]What tests should I do when my eyelids are swollen [expert's advice]Cough after high blood pressure medication [Expert's Advice]I am 12 years old and I think that I am fat [expert's advice]For how longhepatitis B vaccine gives immunity? [Expert advice]Ineffective treatment of bronchitis [Expert advice]Failed treatment of giardiasis [Expert Advice]Blood test standards for a 6-year-old [Expert's advice]Symptoms of phase II sarcoidosis [Expert's advice]Obesity and the treatment of hypothyroidism [Expert advice]I almost always have cold feet and hands [Expert Advice]The causes of brittle, brittle, falling out hair [Expert's advice]Diagnosing myocardial infarction after heart transplant [Expert advice]Varying Opinions About Back Surgery [Expert Advice]Self-removal of an abscess on the tonsils [Expert's advice]Persistent clinks of the legs after childbirth [Expert advice]Visualization of veins with hormone treatment [Expert's advice]