There are several treatment options for pheochromocytomas/paragangliomas:
There is not an overarching treatment used for all pheochromocytoma/paraganglioma patients and treatment options are recommended on a case-by-case basis. The most common treatment of solitary pheochromocytomas remains surgical resection.
Patients with solitary tumors or multiple tumors clustered in one area of the body will often undergo surgical treatment, which involves the surgical removal of the offending tumors. Prior to surgery patients will undergo what is known as the blockade. The blockade is the administration of several drugs that will help maintain the patient's blood pressure in an attempt to prevent complications while under anesthesia.
MIBG treatments are generally used for patients with metastatic disease who are MIBG positive. MIBG is a radioactive compound that is often taken up by pheochromocytoma/paraganglioma cells. When administered in high doses, MIBG has the ability to kill off tumor cells and reduce the size of the tumors.
Chemotherapy is mainly used for the patients in whom pheochromocytomas are rapidly growing, especially when multiple-organ lesions are present and a surgical approach is not feasible. Chemotherapy cycles are normally given every 3 weeks and the doses are adjusted according to the patient's blood count and tolerance.
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Radiotherapy uses high powered x-rays or radioactive beams to kill cancer cells. Radiation is most harmful to rapidly growing cells, so radiation therapy damages cancer cells more than normal cells. Specifically, radiation therapy damages the DNA of cancer cells, which prevents the cancer cells from growing and dividing.
Radiofrequency ablation is an alternative to surgical removal of a tumor and is performed by an interventional radiologist. Radiofrequency ablation involves inserting a needle into the tumor and charging the needle to essentially "cook" the tumor. This is a safe and effective tumor destruction technique. Like with surgery, tumors will undergo a blockade before radiofrequency ablation to avoid complications while under anesthesia.
Cryoablation is a minimally invasive treatment that uses extreme cold to freeze and destroy diseased tissue, including cancer cells. During cryotherapy, liquid nitrogen or argon gas is applied to diseased cells located outside or inside the body. Physicians use image-guidance techniques such as ultrasound, computed tomography (CT) or magnetic resonance (MR) to help guide these freezing substances to treatment sites located inside the body.