Hi, my name is Lori Ann Blakeley.

Welcome to my Web site developed and maintained on my behalf by my father, Larry Blakeley. http://www.royblakeley.name/larry_blakeley/larryblakeley_photos_jpeg.htm

My father also manages the following Web sites:

Larry Blakeley (Contact Info: larry at larryblakeley.com)

Major Roy James Blakeley (USAF - KIA) (December 10, 1928 - July 22, 1965) - my grandfather

Leslie Blakeley Adkins - my older sister

Evan Blakeley- my younger brother 

Lori's Paper http://www.angelfire.com/journal2/loripaper/

Saturday, 26 March 2005
Adrenal Carcinoma
By Stephanie Chavarie
Biology 1401
Dr. Deanna Noyes
March 22, 2005

Stephanie Chavarie
Biology 1401
Dr. Deanna Noyes
March 22, 2005

Adrenal Carcinoma

My close friend from high school, Lori Blakely, is affected with this disease right now. She was diagnosed in mid-November, and was taken out of college and brought home to undergo treatment. The way that they found she had this type of cancer was when she got sick with a type of pneumonia that would not go away, and learned that instead of pneumonia, she had a tumor that was pressing against her lungs and inhibiting her breathing. After taking samples of the tumor, doctors discovered that it was cancerous and moving towards her heart. After deducing that surgery was too perilous at this point, they prescribed her with treatments of chemotherapy which she is currently undergoing. At first, they had trouble finding what cancer it was, thinking it was lymphoma, then sarcoma, but finally diagnosing it as adrenal carcinoma. The reason it was so hard to identify is because of the size of the mass, about 15 centimeters, located near her right atrium and lung. Many procedures were used to determine this, including a needle biopsy, a small surgery where part of the tumor was removed, and a bone marrow sample (which returned negative, thankfully). After finally identifying the tumor, progress of the treatment for Lori’s cancer slowed, due to the Christmas and new year’s holidays coming up. Such delay distressed her parents, (as it would with anyone with a child suffering from cancer) and they searched for a new doctor that would meet more frequently with them and focus more on Lori. After finding a new doctor, Lori’s treatment got underway, and she is now on chemotherapy to try and reduce the mass of her tumor because until it moves away from her heart, surgery is not possible. To administer the chemotherapy Lori had an implantable port placed in her chest. For the first stages of chemo, she was given cisplatin (platinol), gemcitabine (gemzar), ketoconazole (nizoral), and lysodren (mitotane). Cisplatin is in a class of drugs known as platinum-containing compounds. It is supposed to slow or stops the growth of cancer cells in the body. The length of treatment depends on the types of drugs being taken by the patient, how well their body responds to them and they type of cancer the patient has (Medline plus). Gemcitabine interferes with the growth of cancer cells, which are eventually destroyed. Unfortunately, this treatment can affect the growth of normal cells and other effects may occur. Some of these could have serious side effects which the doctor should talk to the patient about. Other effects, like hair loss, may not be serious but may cause concern. Some effects may even still occur after treatment with gemcitabine has been stopped (Medline plus). Ketoconazole is used to treat skin infections such as jock itch, athlete's foot, and ringworm; and fungal infections of the fingernails, toenails, mouth (thrush), lungs, and blood. I was unable to find what this has to do directly with her cancer, but assume it is just in connection with some of the other drugs she is taking (Medline plus). Mitotane is a medicine that acts specifically on the adrenal cortex. It is used to treat some kinds of cancer that affect the adrenal cortex. It can also be used when the adrenal cortex is overactive, but not cancerous. Mitotane reduces the amounts of adrenocorticoids (cortisone-like hormones) produced by the adrenal cortex. These steroids are important for various functions of the body, including growth. However, too much of these steroids can cause problems (Medline plus). After another infusion of gemzar, two weeks later, Lori had a transesophageal echocardiogram to determine whether or not the size of her tumor had gone down. The tumor had not been reduced, but had not grown, so she took another round of chemotherapy to see if it would reduce the size, and thus make surgery less risky and traumatic. After another intravenous transfusion of cisplatin and gemcitabine, Lori was scheduled to have surgery done in three weeks, at the National Institutes of Health, Bethesda, Maryland. Unfortunately, during that weekend (Feb. 26/27) Lori became confused and lethargic. After being rushed to the hospital, tests indicated that her bilirubin (a breakdown product of hemoglobin) levels were elevated to 11.7. This was very distressing as normal levels are 0-1 and chemotherapy levels are usually 3-5. If the level had not dropped, it would be an indication of liver failure. However, prayers were answered when lab tests showed that her bilirubin level had dropped back down to 5. Lori went through one more treatment of chemotherapy, and as of now is scheduled for probable surgery on April 6th, depending on how her latest image test turns out.

Adrenal carcinoma is cancer of the adrenal cortex, and very rare, only occurring in 1 of 2,000,000 cancer occurrences. Malignant cells are found in the adrenal cortex, which is the outside layer of the adrenal gland. Cancer of the adrenal cortex is also called adrenocortical carcinoma. There are two adrenal glands, one above each kidney in the back of the upper abdomen. The adrenal glands are part of the endocrine system (Adrenocortical Carcinoma - website). Adrenal cancer accounts for only 0.2% of deaths due to cancer, however, it tends to be highly malignant and difficult to treat. Approximately 50% of these tumors are functioning and produce hormonal and metabolic syndromes leading to their discovery. The other 50% are silent and discovered only when they are so large that they produce localized abdominal symptoms or when they metastasize (Cushing), such as Lori’s. As of now, the cause of adrenal cancer is still unknown, but studies in the past few years imply genetic mutations in the adrenal gland lead to the beginning of a cancerous tumor. Occasionally, this type of cancer develops in families that exhibit susceptibility to other types of cancers. In the studies conducted, it was noted that environmental factors should be included because in Brazil the tumor distribution follows a regional pattern as opposed to a familial one. Another thing to be noted about the spread of this cancer in Brazil would be that the occurrence of this type of cancer in young children is unusually high, “ranging from 3.4-4.2 per million children, compared with a worldwide incidence of 0.3 per million children younger than 15” (Cushing’s).

There are four stages to adrenal carcinoma. Patients in stage I have tumors that measure less than 5 cm in size and have no evidence of lymph node involvement or metastases; patients in stage II have tumors larger than 5 cm but are also free of lymph node involvement or metastases. Patients in stage III exhibit tumors of any size with local lymph node invasion or have experienced local recurrence. Patients in stage IV have distant metastases. The most common sites of tumor spread in stage IV are lung, liver, lymph nodes, and bone. The stage at which an adrenal cortical carcinoma is defined determines prognosis for life expectancy. While 50% of patients in stages I, II or III are alive 40 months after diagnosis, only 10% of patients in stage IV are alive at that time (Cushing’s).

There are many treatment options for adrenal carcinoma, including surgery, mitotane, radiation therapy, and systematic chemotherapy. Many doctors say that surgery should be considered in the initial step of treatment, just to try to reduce the mass as much as possible. Studies show that after initial reduction, 56% of the patients have extended survival rates. Though adrenal cancer is usually resistant to radiation therapy, three-dimensional conformal radiotherapy may prevent recurrence of the tumor if directed to the adrenal bed after local tumor recurrence and repeat surgical excision (Cushing‘s). This form of radiotherapy usually provides no complications for the patient, and has no evidence of recurrence at least one year of follow up. However, not many patients have had this treatment, so the success rate of this is not easily determined. Mitotane is an adrenalytic (adrenal destroying) drug with selective activity on the adrenal cortex which has been found to be effective in inducing a tumor response in 33% of patients treated (Cushing‘s). When used before the metastatic stage, mitotane has been impressive enough to even “cure” patients of adrenal carcinoma.

Though it has been hard to determine through the doctoral jargon, it appears that the life expectancy rate for adrenal carcinoma is not a high one. The lack of straight forward answers you can find about this cancer seems to be very high, and I often found myself going in circles or coming to the end of a section without having learned anything new. This occurs most in the life expectancy and recurrence statistics. While not many people are affected by this disease, their friends and family are still effected by it, and more information should be given out about it when more is found.

Bibliography

Adrenocortical Carcinoma - http://pages.zdnet.com/beverlin/adrenocorticalcarcinoma/
Cushing’s Support and Research Foundation - About Adrenal Cancer - http://csrf.net/ADRENAL_CANCER_Steingart.htm
Lori’s Medical Updates - http://www.lori.blakeley.name/lori_medical_updates.htm
MedlinePlus Health Information from the National Library of Medicine - http://medlineplus.gov/
National Cancer Institute - Adrenocortical Carcinoma Treatment - http://www.nci.nih.gov/cancertopics/pdq/treatment/adrenocortical/

Posted by journal2/loripaper at 8:38 PM MST
Updated: Saturday, 26 March 2005 8:45 PM MST