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Below, week by week, is what OnCo's record of Advanced and metastatic adrenocortical carcinoma (ENSAT stage IV or unresectable) says about the first two months: the order is typical, the timing is yours to ask about. Advanced adrenocortical carcinoma is adrenal cortex cancer that has spread to distant organs or cannot be removed. The standard is mitotane with etoposide, doxorubicin and cisplatin, established by the FIRM-ACT trial in 304 patients; limited spread is treated locally, hormone excess with steroid-blocking drugs, and immunotherapy helps a minority. Sections appear only where the record has something to say. Orientation, not medical advice.
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
Mitotane from diagnosis with glucocorticoid replacement; adrenal enzyme inhibitors (metyrapone, osilodrostat, ketoconazole) for cortisol excess; thromboprophylaxis and infection vigilance.
Mitotane alone, with resection, thermal ablation or stereotactic radiotherapy of limited metastases.
Etoposide, doxorubicin and cisplatin with mitotane (EDP-M, FIRM-ACT).
Gemcitabine with capecitabine; cabozantinib; pembrolizumab, especially for mismatch-repair-deficient tumours; streptozocin-mitotane; clinical trials.
Relacorilant with checkpoint inhibition for cortisol-secreting tumours; cabozantinib with immunotherapy; radiolabelled CYP11B tracers.
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
Every term links to the glossary.