To remove the tumor from the vein, the surgeon may need to bypass the body's circulation by putting the patient on a heart-lung bypass pump like that used in heart surgery. If this is the case, it requires a very extensive operation to remove the tumor completely and preserve the vein. Sometimes, the cancer can grow into the inferior vena cava, the large vein that carries blood from the lower body to the heart. If it has grown into the muscle and fat around the adrenal gland, these tissues will need to be removed as well. For example, if the cancer has grown into the kidney, all or part of the kidney must also be removed. It also gives the surgeon room to remove a large cancer that has grown into tissues and organs near the adrenal gland. This lets the surgeon see the tumor more clearly and makes it easier to see if it has spread. More often, the surgeon makes the incision through the front of the abdomen. This works well for small tumors, but it can be hard to see larger tumors well. One way to remove the adrenal gland is through an incision in the back, just below the ribs. If nearby lymph nodes are enlarged, they also will need to be removed and checked for cancer spread. The surgeon will try to remove as much of the cancer as possible, including any areas of cancer spread. The main treatment for adrenal cancer is removal of the adrenal gland, an operation called an adrenalectomy.
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