DEAR DR. ROACH: Could you please explain what makes a pheochromocytoma cancerous, what the symptoms are, what the protocol for treatment is and where the best places for treatment might be, as very little is known about this kind of cancer? — P.L.

ANSWER: A pheochromocytoma (fee-oh-kroh-moh-sigh-TOH-muh) is a rare tumor that usually secretes epinephrine and norepinephrine, substances that increase blood pressure. More than 90 percent of people with this tumor will have high blood pressure, and typical symptoms include headache, sweating and heart racing. Not everyone has all of these symptoms. They can occur at any age but are most common in the 40-50 age group. Only about 1 person in 500 with hypertension will have a pheochromocytoma. These tumors usually arise in the adrenal gland, but can occur in other locations, where they may be called paragangliomas.

Even though 90 percent of pheochromocytomas are not malignant, it does not mean it is a benign condition. The degree of blood pressure elevation can itself be life-threatening, and it particularly may be a problem during surgery, especially if the condition is unknown at the time. In the even rarer situation of a malignant (cancerous) pheochromocytoma, the situation is substantially harder to cure because of the cancers themselves as well as the hormones they secrete. Even a benign-appearing pheochromocytoma, which has been successfully removed surgically, can recur up to 20 years later with evidence of cancerous spread, so all need to be carefully monitored.

All people with pheochromocytomas need to be treated by experts. A solitary pheochromocytoma is removed surgically. Medication to block the effects of the epinephrine and norepinephrine must be given before surgery, and an experienced anesthesiologist is critical.

For cancerous pheochromocytomas, I would recommend treatment at a specialty cancer hospital, of which there are several in the country. This is yet another situation where a greater degree of personal and institutional experience translates to better cure rates. Malignant pheochromocytomas are treated with some combination of surgery, chemotherapy and radiation.

There are cases of these kinds of tumors that run in families. People who present with multiple tumors or have a family history may undergo genetic screening.

More information about these tumors is available at A support group is available at

DR. ROACH WRITES: I wrote a column on cracked fingertips, and once again received a wealth of suggestions for prevention and treatment from readers.

For prevention, some suggestions I liked included avoiding too-hot water for handwashing, antibacterial soaps and wool gloves, all of which can remove protective oils from your fingers. A humidifier in the house can prevent drying of all the skin.

Home-treatment remedies I heard about included flax-seed oil or B vitamins by mouth. I don’t know if these are effective, but they should be safe. Most people recommended emollients to the hands, specifically Preparation H, O’Keefe’s Working Hands, Bag Balm, CeraVe, Chapstick and Carmex Healing Cream. Plain petrolatum (Vaseline) works very well for many people and is inexpensive. The area can be covered at night by a bandage or glove.

Several people recommended saltwater soaks. One noted that the pure mountain water of Colorado Springs cured him in three days. Finally, one person recommended trimming the nails quite short. These home remedies have helped many.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from

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