Adrenocortical Carcinoma (ACC) Treatment in India
Adrenocortical Carcinoma (ACC) is a rare but highly aggressive cancer of the adrenal gland. India has become a global hub for ACC treatment, combining advanced therapies with affordability and expert care. Patients under the supervision of specialists like Dr. Ankur Bahl benefit from a multidisciplinary approach involving surgery, chemotherapy (mitotane), and hormone therapy. The cost of ACC treatment in India ranges between USD 5,000 to 10,000, making it a preferred destination for international patients seeking high-quality cancer care at a fraction of global prices.
What is Adrenocortical Carcinoma (ACC)?
Adrenocortical Carcinoma (ACC) is a rare and aggressive cancer that originates in the outer layer (cortex) of the adrenal gland. These glands sit on top of the kidneys and are responsible for producing essential hormones such as cortisol, aldosterone, and androgens. ACC can either be functional (producing excess hormones) or non-functional. It often spreads to nearby tissues or distant organs by the time of diagnosis. ACC affects approximately 1-2 individuals per million annually, with peaks in children under 6 and adults between 30–40 years old.
What are the Causes and Risk Factors of Adrenocortical Carcinoma (ACC)?
While the exact cause of ACC is unknown, several risk factors are associated with its development:
- Genetic-disorders: Beckwith-Wiedemann syndrome, Li-Fraumeni syndrome and familial adenomatous polyposis
- Hormonal-disorders: Cushing’s syndrome, Conn syndrome, virilization, and feminization
- Radiation exposure
- Certain environmental chemicals
- Family history of adrenal cancers
What are the Diagnosis of Adrenocortical Carcinoma (ACC) in India?
ACC is a rare and aggressive malignancy of the adrenal cortex. Diagnosis requires a multimodal approach, integrating imaging, hormonal evaluation, and pathology.
1. Biochemical Evaluation (Hormonal Workup)
Most ACCs are functionally active and secrete hormones:
| Hormone Test | Purpose |
|---|---|
| Serum Cortisol (including Dexamethasone Suppression Test) | Detects Cushing's syndrome (hypercortisolism) |
| DHEA-S, Testosterone, Estradiol | Detects virilizing/feminizing tumors |
| Plasma Aldosterone & Renin Ratio | Rules out primary aldosteronism (less common in ACC) |
| Serum/Urine Catecholamines (to rule out pheochromocytoma) | Preoperative safety check (though rare in ACC) |
These tests are readily available in tertiary hospitals and endocrine labs across India (e.g., Fortis, AIIMS, Medanta, Apollo).
2. Imaging Studies
| Imaging | Purpose | Availability in India |
|---|---|---|
| CT Scan (Abdomen with contrast) | First-line for adrenal mass evaluation | Widely available across India |
| MRI (Abdomen) | Better soft tissue resolution, used for surgical planning | Available in all major cities and private centers |
| PET-CT (FDG) | Differentiates benign vs malignant, evaluates metastasis | Available at major oncology hospitals (Tata, Fortis, Apollo) |
| Adrenal Protocol Imaging | Includes delayed washout CT to differentiate ACC from adenoma | Available in top-tier centers |
3. Histopathology & Immunohistochemistry (IHC)
| Procedure | Purpose |
|---|---|
| Biopsy (FNAC is avoided) | Usually avoided unless metastasis suspected |
| Histopathology (post-surgery) | Required for definitive diagnosis |
| Weiss Criteria | Used to determine malignancy (score ≥3) |
| IHC Markers: SF-1, Ki-67, inhibin | Confirm ACC and guide prognosis |
Ki-67 index is crucial for grading and treatment planning. Most major Indian pathology labs now support ACC-specific IHC panels.
📊 Staging of Adrenocortical Carcinoma (ENSAT System)
India follows the ENSAT (European Network for the Study of Adrenal Tumors) classification for staging ACC:
| Stage | Definition |
|---|---|
| Stage I | Tumor ≤5 cm, no local invasion, no metastasis |
| Stage II | Tumor >5 cm, no local invasion or metastasis |
| Stage III | Local invasion into surrounding tissue or lymph node involvement |
| Stage IV | Distant metastasis (lungs, liver, bone, etc.) |
Imaging + surgical pathology is used for accurate staging.
What are The Treatment Options for Adrenocortical Carcinoma (ACC) in India?
1. Surgical Removal (Adrenalectomy):
This is the primary curative treatment for localized Adrenocortical Carcinoma (ACC). Even in cases with major vessel involvement, surgery may be attempted.
2. Chemotherapy:
Mitotane, a drug inhibits adrenal steroid synthesis. This may be used alone or with agents like cisplatin, doxorubicin, and etoposide.
3. Radiation Therapy:
Primarily used for palliative care in cases with bone metastasis or local recurrence.
4. Hormone Replacement Therapy:
Post-surgery, hormone replacement becomes essential due to adrenal insufficiency.
5. Targeted Therapy and Clinical Trials:
New therapies are being explored, but they are not yet standard practice.
6. Debulking Surgery:
If full removal isn’t possible, debulking helps reduce tumor load and manage hormone excess.
7. Palliative Care:
For advanced cases, symptom control and quality-of-life improvement become the focus.
Leading Oncologist for Rare Cancers
Dr. Ankur Bahl, a senior medical oncologist at Fortis Memorial Research Institute, Gurgaon, is among India’s top specialists for treating rare cancers like ACC. With extensive experience in managing aggressive tumors, Dr. Bahl offers advanced treatments combining surgery, mitotane-based chemotherapy, hormone management, and long-term follow-up strategies.
What Support for International Patients are Available?
- Medical visa and document support
- Personalized care coordinators
- Airport transfers and affordable accommodation
- Post-treatment care and hormone follow-up
- Language interpretation and cultural support
Organizations streamline the entire journey, ensuring you receive care from top hospitals and experts like Dr. Ankur Bahl.
Contact with us for Expert ACC Treatment in India
If you or your loved one is diagnosed with Adrenocortical Carcinoma, Healzone can help you connect with Dr. Ankur Bahl and India’s top cancer hospitals. Get affordable, expert-led treatment and full travel support tailored for international patients. Reach out today!
Adrenocortical Carcinoma (ACC) Treatment Cost Comparison: India vs. Turkey vs. USA
India has become a preferred destination for affordable and high-quality ACC treatment, with access to leading oncologists, modern facilities, and advanced therapies like mitotane and laparoscopic adrenalectomy.
| Treatment Type | India (USD) | Turkey (USD) | USA (USD) |
| Adrenalectomy (Open or Laparoscopic) | $4,000 – $7,000 | $8,000 – $12,000 | $30,000 – $60,000 |
| Radical Resection with Lymphadenectomy | $6,000 – $9,000 | $10,000 – $15,000 | $40,000 – $70,000 |
| Mitotane Therapy (monthly) | $500 – $1,000 | $1,200 – $2,000 | $5,000 – $8,000 |
| Chemotherapy (EDP-M protocol) per cycle | $700 – $1,500 | $1,000 – $2,000 | $10,000 – $20,000 |
| Radiation IGRT | $6000 | $15000 | $30,000 – $50,000 |
| Radiation IMRT | $5000 | $15000 | $30,000 – $50,000 |
| Radiation V-MAT | $6500 | $15000 | $30,000 – $50,000 |
| PET-CT Scan | $300 – $500 | $500 – $800 | $3,000 – $6,000 |
| Hormonal & Tumor Marker Testing (Cortisol, DHEA, Ki-67, IHC) | $200 – $500 | $400 – $700 | $2,000 – $4,000 |