From 1962 to 1985, 47 patients with carcinoma of the adrenal cortex were treated at Memorial Sloan-Kettering Cancer Institute. There were 21 men and 26 women. Seventy-two percent of the tumors were functional and 28% were nonfunctional. Despite the advent of ultrasonography and computerized tomography, these tumors were infrequently diagnosed until they infiltrated adjacent organs or metastasized to distant sites. Only 30% of patients had tumors confined to the adrenal gland; their mean duration of survival was 5.0 years. Seventy percent of the patients had invasion of the kidney, lymph nodes, liver, diaphragm, and/or pancreas at the initial operation; their mean duration of survival was 2.3 years. Eight patients had reoperation for abdominal recurrences; three of the patients with abdominal recurrence and one additional patient underwent thoracotomy to resect localized lung metastases. The mean duration of survival of these nine patients was 3.5 years, not significantly different from the mean overall survival of 3.1 years. The duration of survival of all patients was not significantly correlated with age, sex, adjuvant therapy, or production of hormones by the tumor. Only two patients were deemed unresectable. Wide en-bloc dissection of the primary tumor, resection of contiguous organs for local invasion, and excision of resectable metastases in the liver and lungs remain the basis of therapy.