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Adrenal Cancer Prevention: What Is Known, and What Actually Helps
Most guides about cancer prevention start with a list of things you can change. This one has to start somewhere else, because adrenal cancer is different. There is no known avoidable cause, and for most people this disease cannot be prevented.
What we can do is tell you the truth and then point you toward the things that genuinely matter. Those things are real: genetic counseling, planned monitoring for families with an inherited syndrome, taking hormone symptoms seriously, and making sure an adrenal mass gets a proper workup. This guide is centered on adrenocortical carcinoma, or ACC (cancer of the adrenal cortex, the outer layer of the adrenal gland), which is what most people mean by adrenal cancer.
Adrenal cancer affects women and men, adults and children. Nothing here is a substitute for talking with your own care team about your own situation.
Source: National Cancer Institute - Credit: Terese Winslow
Is Adrenal Cancer Preventable?
For the large majority of people, no. The American Cancer Society states it plainly: "Since people with adrenal cortical cancers have no known preventable risk factors, it is not now possible to prevent this disease, specifically." The National Cancer Institute goes a step further and notes that it does not even have evidence-based prevention information for adrenocortical carcinoma, because there is not enough evidence to build it from. If you have been searching for the thing you should have avoided, that thing has not been found, and it may not exist.
There are two reasons for this. The first is that adrenocortical carcinoma is genuinely rare. The National Cancer Institute puts the annual incidence at about 2 cases per 1 million people. When a disease is that uncommon, it is extremely hard to run the kind of large study that could link it to a food, a chemical, a job, or a habit. No such link has held up. The second reason is more fundamental: a substantial share of cases trace back to inherited gene changes that were present from the moment a person was conceived. In children with adrenocortical carcinoma, predisposing genetic factors have been found in more than half of cases in North America and Europe, and in about 95% of cases in southern Brazil, where a specific founder change in the TP53 gene is common. You cannot avoid a gene you were born with.
You did not cause this. Not by what you ate, not by stress, not by anything you did or failed to do. Adrenal cancer is not a lifestyle disease. Learning that a hereditary syndrome runs in a family can bring a wave of guilt. No one chooses which genes they pass on, and no one knows.
So what can actually be changed? Not whether adrenal cancer happens, but how early it is found and how well it is treated. That distinction is not a consolation prize. It is the single biggest lever anyone has here. Complete surgical removal of the tumor is the treatment that gives the best chance of long-term disease-free survival, and the National Cancer Institute lists completeness of resection as one of the three most important prognostic factors, alongside stage and pathological grade. Tumors found smaller and earlier are far more likely to come out completely. That is why early detection, rather than prevention, is where your energy is best spent.
There are four concrete actions that you can take to improve your outcomes
Ask about genetic counseling if there is a pattern of cancer in your family, especially cancers at young ages.
If a hereditary syndrome is confirmed, get onto a planned monitoring schedule set by a genetics team.
Take hormone symptoms seriously and keep pushing until they are explained, because most adrenal cancer symptoms come from hormones rather than from the tumor pressing on something.
If a mass is found on your adrenal gland, follow through on the full workup instead of letting it drift.
Also be aware that cancer that started somewhere else and spread to the adrenal gland is called an adrenal metastasis. That is not adrenal cancer. It is treated as whichever cancer it started as, and nothing in this guide about prevention or hormone symptoms applies to it in the same way. Separately, the great majority of lumps found on the adrenal gland are benign, meaning not cancer at all. If a scan just found something on your adrenal gland, the odds are strongly in your favor, and our guide to how adrenal cancer is diagnosed walks through what happens next.
Pheochromocytoma Is a Different Adrenal Cancer and Works Differently
Pheochromocytoma and paraganglioma, often shortened together to PPGL, start in the adrenal medulla (the inner core of the gland) rather than in the cortex. They release adrenaline-type hormones called catecholamines, so they cause spells of pounding heartbeat, sweating, headache, and blood pressure surges instead of the slow hormone changes seen in ACC. Prevention is the same story: there is no way to prevent them either. But the genetics are different, involving genes such as SDHB, SDHD, VHL, RET, and NF1, and that changes who should be tested and monitored. The National Cancer Institute is explicit that everyone diagnosed with pheochromocytoma or paraganglioma should have genetic counseling, and that people with an inherited form need lifelong follow-up.
Best Foods for Adrenal Cancer Prevention
No food prevents adrenal cancer. Not broccoli, not turmeric, not green juice, not any eating pattern. No trial has ever shown a food or nutrient that lowers adrenal cancer risk, and given how rare the disease is, no such trial is likely to be run. The National Cancer Institute puts the broader point this way: "with few exceptions, studies of human populations have not yet shown definitively that any dietary component causes or protects against cancer." If a website promises you an adrenal cancer diet, it is not scientifically proven.
What does have real evidence behind it is a general eating pattern that lowers overall cancer risk. The World Cancer Research Fund estimates that around 40% of cancer cases could be prevented if people followed its recommendations, and it stresses that the recommendations work as a package rather than as items to pick from. None of these is specific to adrenal cancer, and we are labeling them clearly as general cancer prevention and general health advice:
Be a healthy weight: Staying within a healthy weight range for your body is the recommendation the World Cancer Research Fund emphasizes most.
Be physically active: Regular movement is recommended in its own right, not only as a way to manage weight.
Eat wholegrains, vegetables, fruit and beans: These form the base of the pattern, rather than any single food being protective.
Limit fast foods: This is framed as limiting a whole category of processed food high in fat, starches, or sugars.
Limit red and processed meat: The strongest evidence here concerns bowel cancer, which is a different disease.
Limit sugar-sweetened drinks: Water and unsweetened drinks are recommended instead.
Limit alcohol consumption: For cancer prevention, the recommendation is not to drink alcohol.
Do not use supplements for cancer prevention: The recommendation is to meet nutritional needs through food.
Now the part that is genuinely specific to this disease, and genuinely useful: nutrition during adrenal cancer. Roughly 60% of adrenocortical carcinomas make extra hormones, and hormone testing finds signs of hormone production in up to 80%. Those hormones change how your body handles food, so nutrition during treatment is not a side topic. It is part of the medical picture.
Too much cortisol, which produces Cushing syndrome, pushes blood sugar up, breaks muscle down, and thins bone. Practically, that means blood sugar may need watching even if you have never had diabetes, that spreading protein through the day is worth discussing as a way to protect muscle, and that bone health belongs on your list of things to ask about. The 2023 European Society of Endocrinology guideline on adrenal masses recommends screening people with autonomous cortisol production for high blood pressure and type 2 diabetes, and suggests checking for spine fractures, which tells you how real the bone and metabolic effects are. Too much aldosterone, which produces Conn syndrome, raises blood pressure and can drive potassium low. Low potassium causes muscle cramps, weakness, and an odd fluttering feeling in the chest, and it is managed with blood tests and, when needed, potassium replacement prescribed by your team rather than guessed at with food alone.
Mitotane, the one drug approved specifically for adrenocortical carcinoma, brings its own nutrition issues. Loss of appetite, stomach discomfort, nausea, vomiting, and diarrhea are among its most common side effects, and they can make eating enough a daily project. Mitotane is also absorbed better with fat. The United States label instructs patients to take it with food and states that administration with high-fat food enhances absorption, and the European product information tells patients to swallow the tablets with a glass of water during meals containing fat-rich food such as milk, chocolate, or oil. Both labels are careful to note that a formal food effect study was never done, so treat this as guidance to follow from your own prescriber rather than a rule you adjust on your own. What matters just as much is consistency: the label says the timing of the dose relative to meals must be kept the same.
All of this is a strong argument for working with an oncology dietitian, which is a dietitian trained in cancer care. Most cancer centers have one; referrals are usually straightforward, and the visit is often covered. A dietitian can help you eat enough while cortisol is driving blood sugar up, keep protein high enough to protect muscle, work around mitotane side effects, and time meals so your medicine absorbs the way it should. That is a far better use of your effort than any anticancer food list. Our guide to adrenal cancer treatment covers what else to expect.
Are There Medications That Help Prevent Adrenal Cancer?
There is no medication that prevents adrenal cancer. Using a drug to stop cancer before it starts is called chemoprevention, and it exists for a few cancers, such as tamoxifen or raloxifene for women at high risk of breast cancer. Nothing comparable exists here. The National Cancer Institute has no evidence-based prevention summary for adrenocortical carcinoma at all, and no chemoprevention trial supports taking any drug to avoid this disease. If you were hoping for a daily tablet, that option does not exist.
Mitotane is often mistaken for one, so it is worth being precise. Mitotane is a treatment, not a preventive treatment. It is used for advanced adrenocortical carcinoma, where it can shrink tumors in some people and, more often, calm down hormone symptoms. In advanced disease, it is used either on its own or together with the chemotherapy combination of etoposide, doxorubicin, and cisplatin, depending on how aggressive the cancer looks.
Mitotane also has a second role, and this is the one people confuse with prevention. After surgery that removes all visible cancer, mitotane can be given as adjuvant therapy, meaning extra treatment aimed at lowering the chance the cancer comes back. That is preventing a recurrence in someone who already has the diagnosis. It is not preventing the disease in a healthy person. The two are completely different things.
Current guidelines are cautious about it, and it is worth knowing how cautious.
The 2018 European Society of Endocrinology and European Network for the Study of Adrenal Tumors guideline suggests adjuvant mitotane for patients with
No visible remaining tumor after surgery
Perceived high risk of recurrence, which the guideline describes as ENSAT stage III, or an R1
Resection meaning microscopic cancer left at the edge
A Ki67 index above 10%
For people at low or moderate risk, the panel could not recommend for or against it and said the decision should be individualized.
Stage I or II with a clean R0 resection and Ki67 of 10% or less
When mitotane is used this way, the guideline suggests giving it for at least 2 years but not longer than 5 years in people who stay recurrence-free and tolerate it. The recommendation carries the lowest evidence grade the panel uses. The National Cancer Institute lists adjuvant mitotane as being under clinical evaluation and notes it has shown some progression-free or disease-free survival advantage but no overall survival advantage.
The ADIUVO trial, the first randomized study of adjuvant mitotane, enrolled mostly lower-risk patients and did not find a significant difference in recurrence-free or overall survival between the mitotane group and the observation group. This is a real conversation to have with an adrenal specialist, not a settled answer.
A separate group of drugs blocks the effects of adrenal hormones. These control hormone excess. They do not prevent or treat the cancer itself.
Metyrapone and ketoconazole reduce how much steroid hormone the body makes
Osilodrostat works in a similar way and is used in Cushing syndrome
Spironolactone and mifepristone block hormone receptors
The National Cancer Institute notes that in patients with increased hormone production, drugs such as ketoconazole and metyrapone, and receptor blockers such as spironolactone and mifepristone, should be considered. One caution worth flagging: the mitotane label says to avoid using spironolactone at the same time, because spironolactone may block the action of mitotane. These medicines can make someone feel dramatically better, but nobody should think of them as cancer prevention.
Finally, mitotane interacts with a great many other medicines, which is a practical reason to keep one accurate medication list. Mitotane is a strong inducer of a liver enzyme system called CYP3A4, which means it can lower the levels of many other drugs and make them stop working properly. The label specifically warns that mitotane may reduce the effect of warfarin, a blood thinner, and can make hormonal contraceptives ineffective. The European guideline advises that all other medicines be checked for these interactions and that other care providers not start new drug therapies without consulting the team managing the mitotane.
Are There Supplements That Help Prevent Adrenal Cancer?
No supplement prevents adrenal cancer. No vitamin, no mineral, no mushroom extract, no antioxidant blend, no herbal formula. There is no trial showing any supplement lowers adrenal cancer risk. One of the ten World Cancer Research Fund recommendations is simply: do not use supplements for cancer prevention. The National Cancer Institute states that vitamin and dietary supplements have not been shown to prevent cancer, and adds that research in humans has not convincingly shown that antioxidant supplements reduce the risk of developing or dying from cancer, with some studies even finding a higher risk of certain cancers. In the large SELECT trial, vitamin E taken alone actually increased prostate cancer risk, and the risk continued after men stopped taking it.
For adrenal cancer specifically, there is a more immediate problem than lack of benefit, and it is the reason this section matters. Supplements can distort the hormone test results that this disease is diagnosed and monitored with. The most important example is biotin, sometimes sold as vitamin B7 and marketed for hair, skin, and nails. Many laboratory tests, including hormone tests, use a biotin-based technology, and extra biotin in the blood can push results falsely high or falsely low depending on the test. The United States Food and Drug Administration has warned about this repeatedly and notes that biotin is used in hormone tests. The National Institutes of Health Office of Dietary Supplements is blunter: "Even a single 10 mg dose of biotin has interfered with thyroid function tests administered within 24 hours of taking the supplement." A distorted hormone result in adrenal disease can send a workup in the wrong direction entirely. Tell your team if you take biotin, and ask whether to stop it before testing.
Licorice is the other one to know about. Licorice contains a compound called glycyrrhizin, which affects the same hormone pathway that aldosterone works through. The National Center for Complementary and Integrative Health warns that glycyrrhizin can cause serious effects such as irregular heartbeat, especially in larger amounts or over a long time, and that even small amounts have been linked to severe effects in people with high blood pressure or heart or kidney conditions. It also notes that interactions between licorice and corticosteroids have been reported. Published research has linked regular licorice intake to high blood pressure and to low potassium, which is exactly the pattern aldosterone excess produces. If your team is trying to work out why your potassium is low or your blood pressure is high, licorice in any form, including teas and candies, is something they need to know about.
Then there are interactions with treatment. Because mitotane is a strong CYP3A4 inducer, and because many herbal products act on the same enzymes, the potential for interference runs in both directions. The mitotane label explicitly instructs patients and caregivers to tell their providers about all concomitant medications, herbal and dietary supplements. Mitotane also raises the level of hormone-binding proteins in the blood, which the label warns should be taken into account when interpreting hormone assay results. Chemotherapy adds its own concerns, since some supplements affect how the liver processes chemotherapy drugs and some raise bleeding risk.
There is one narrow, sensible role for supplements, and it is worth separating from everything above. If blood tests show you are actually low in something, such as vitamin D, iron, or vitamin B12, your clinician may prescribe a supplement to correct that. That is treating a measured deficiency. It is a completely different act from taking large doses of something you were never short of in the hope of fighting cancer. People on mitotane also usually need steroid replacement, often at higher than standard doses because mitotane speeds up steroid clearance, and that is a prescription your endocrinologist manages, not a supplement.
The practical rule is simple. Give your care team a full written list of everything you take, including vitamins, herbal products, teas, powders, protein drinks, and anything a friend or an online forum recommended. Bring the actual bottles if that is easier. Ask before starting anything new. Nobody will judge you for asking, and supplements are not regulated the way prescription medicines are, so the label is not a guarantee of what is inside. Our guide to questions to ask about adrenal cancer can help you open that conversation.
Preventing a Late Adrenal Cancer Diagnosis
It is not about preventing adrenal cancer, because as the first section explained, that is not something the evidence supports. It is about preventing a late diagnosis, which is something you can influence. The American Cancer Society notes that adrenal cancers are hard to find early and are often quite large by the time they are diagnosed. Every month shaved off that delay improves the odds that the tumor can be taken out completely, and complete removal is the strongest thing on your side.
Start with hormone symptoms, because that is where most delays happen. Cortisol excess causes weight gain in the face and belly, easy bruising, purple stretch marks, thin skin, mood changes, and high blood sugar. Aldosterone excess causes high blood pressure with low potassium. Androgen excess causes new or heavier body hair, acne, a deepening voice, and irregular or absent periods in women, and in men can cause breast growth or reduced sex drive. Estrogen excess in men causes breast growth. In children, extra hormones may show up as early puberty, fast growth, acne, body hair, or a deepening voice. Many people with adrenal cancer spent years being told these changes were stress, aging, weight, or hormones settling down. If your body is changing quickly and nobody has explained it, that is a reason to keep asking, not a reason to accept a vague answer.
The specific thing to ask for is a referral to endocrinology, the specialty that deals with hormones. You can say it in plain words: "These changes came on fast and I would like an endocrinology referral and hormone testing to rule out an adrenal cause." Rapid change is the signal that matters most. Body hair, voice, periods, blood pressure, weight, and blood sugar that shift over months rather than years deserve a hormone workup. The European guideline on adrenocortical carcinoma recommends that every patient with a suspected adrenal cancer get a careful history, a clinical exam for signs of hormone excess, and a detailed hormonal workup covering cortisol, sex hormones, mineralocorticoids, and hormone precursors, with pheochromocytoma also ruled out. You are allowed to ask for that.
If a mass was found on your adrenal gland by accident on a scan done for something else, follow through on the plan. This situation has a name, an adrenal incidentaloma, and it is common. Most of these are harmless. The 2023 European Society of Endocrinology guideline says that a homogeneous adrenal mass measuring 10 Hounsfield units or less on a noncontrast CT scan is benign and needs no further imaging, whatever its size. But masses that do not clearly look benign need a defined next step, usually a repeat scan at 6 to 12 months or a specialist discussion, and every incidentaloma should get a hormone workup including a 1 mg overnight dexamethasone suppression test and measurement of metanephrines to rule out pheochromocytoma. Appointments in that follow-up chain get dropped all the time. Put them in your calendar and ask for the plan in writing. Our guide to adrenal cancer screening explains the difference between screening and this kind of structured follow-up.
Pursue genetic counseling if there is cancer history in your family, and especially if there are cancers at unusually young ages, several different cancers in one person, or a child in the family with cancer. The European guideline recommends that all adults with adrenocortical carcinoma have at least a basic clinical genetic evaluation exploring personal and family history for signs of a hereditary predisposition syndrome. Genetic counseling is a conversation, not a test you are pushed into, and the National Cancer Institute notes it is generally recommended before any genetic testing for inherited cancer risk. It usually starts with the family member who has had cancer, when that is possible. Our guide to risk factors for adrenal cancer describes the syndromes involved.
If a syndrome is found in your family, tell your relatives. This is the single most useful thing anyone in a hereditary cancer family can do, and it is hard, so it helps to plan it. Genetic counselors do this for a living and can give you a family letter written for relatives to hand to their own doctors. Because these gene changes are passed down, a result in you can put a parent, a sibling, a child, or a cousin onto a monitoring plan that catches a tumor while it is still small. In Li-Fraumeni syndrome, monitoring can begin in infancy, so this information can matter very quickly for a young family. Finally, general health measures earn their place here for an honest reason: not staying active, not smoking, sleeping, and treating your blood pressure and blood sugar will not prevent adrenal cancer, but they make surgery safer and treatment easier to tolerate. Talk with your own care team about what applies to you, and our guide to adrenal cancer support can help you find people who understand the rest of it.