Disease Description (Causes and Symptoms)
- Disease name confirmation: Splenic cancer (English: spleen cancer) may be used as a term referring to a malignant tumor occurring in the spleen; however, primary solid cancers arising in the spleen are extremely rare. Because the spleen is rich in lymphoid tissue, malignant diseases occurring in the spleen more commonly appear as lymphoma (a blood cancer) or as metastases from cancers in other organs.
- Causes and pathophysiology: The specific causes of primary solid cancers of the spleen are rarely known, and they generally develop due to abnormal lymphocyte proliferation (lymphoma) or hematogenous metastasis from cancer in another organ. The spleen filters blood, removes aging red blood cells, and participates in immunity (antibody production and pathogen removal), so splenic injury or a mass can cause hematologic and immunologic abnormalities.
- Main symptoms: Pain or a dull discomfort in the left upper abdomen, abdominal bloating (due to splenomegaly or a mass), fever and night sweats (particularly in lymphoma), weight loss, loss of appetite, digestive discomfort (due to pressure on the stomach), and, rarely, acute abdominal pain and shock if the spleen ruptures. A tendency to bleed (bruising or petechiae due to a low platelet count) may occur in lymphatic diseases, but specific symptoms such as vaginal bleeding are not typical symptoms of splenic cancer.
Treatment Methods
- After the diagnosis is confirmed, treatment is determined according to the cause (whether it is primary or metastatic, and the histologic type, such as lymphoma or metastatic cancer), stage, and overall health status.
- Surgery: For an isolated lesion or when there is a risk of rupture, splenectomy (total splenectomy) is the standard treatment. Splenectomy is not essential for survival, but it may increase the risk of immune dysfunction and infection.
- Systemic therapy: For lymphoma, chemotherapy (such as R-CHOP), targeted therapy, or immunotherapy may be used. Metastatic solid cancers are treated with systemic therapy appropriate for the type of primary cancer (chemotherapy, targeted therapy, immuno-oncology drugs, etc.).
- Radiation therapy: In certain situations, it may be used for symptom relief or local control (mainly for lymphoma and similar conditions).
- Invasive biopsy: Image-guided biopsy may be performed to confirm the diagnosis; however, because the spleen is highly vascular, there is a risk of bleeding, so whether to perform it should be decided cautiously.
- Precautions / management of complications:
- Increased risk of infection after splenectomy (particularly susceptibility to encapsulated bacteria) → Vaccination (pneumococcal, meningococcal, and Hib vaccines) and, when necessary, antibiotic prophylaxis are recommended.
- Because a temporary increase in platelets after surgery (reactive thrombocytosis) may increase the risk of thrombosis, blood tests and, if necessary, consideration of anticoagulation are needed.
- In the event of splenic rupture, there is a risk of massive bleeding, and emergency surgery is immediately required.
- Management of side effects of systemic therapy (such as chemotherapy), including bone marrow suppression, infection, and vomiting.
Checklist Before an Outpatient Visit (Including Sample Questions)
- Items/materials to prepare:
- List of medications currently being taken (including prescription drugs, nonprescription drugs, and supplements)
- Allergy history (particularly medication and vaccine allergies)
- Previous test results (blood tests and ultrasound, CT, MRI, or PET images, preferably the originals or on a CD/USB)
- Record of recent changes in symptoms (location and severity of pain, fever, weight changes, digestive symptoms, etc.)
- Bleeding tendency (bruising, nosebleeds, gum bleeding, menstrual changes, etc.) and history of previous surgery or bleeding
- Vaccination history (particularly pneumococcal, meningococcal, and Hib vaccines)
- Information to tell the medical staff in advance during the outpatient visit:
- Whether you are taking anticoagulants (important for assessing bleeding risk)
- Immunosuppressed status (previous anticancer treatment, steroids, etc.)
- Sample questions (items that patients should prepare themselves before the outpatient visit):
- Please make a brief note of your recent symptoms (when they started and how they have changed) and bring it with you.
- Please bring any previous imaging materials that are available.
Examples of General Questions to Ask the Doctor
- "What is the exact histologic type of this disease (for example, lymphoma, metastatic cancer, or primary solid cancer)? Please explain the biopsy results."
- "What treatment options are recommended, and what are the expected benefits and side effects of each?"
- "What vaccinations and preventive measures are needed to prevent infection after surgery (splenectomy)?"
- "How will complications caused by treatment (such as bleeding, infection, or thrombosis) be monitored and prevented?"
Examples of Disease-Specific Questions
- "Is this lesion primary, or does it appear to be a metastasis from another organ (for example, the liver, stomach, or lungs)? Are additional tests, such as whole-body CT or PET, needed to find the primary cancer?"
- "If a biopsy is performed, is there a risk of bleeding? Why do you recommend immediate splenectomy instead of an image-guided biopsy?"
- "If I undergo splenectomy, which vaccines should I receive and when (including the recommended timing before and after surgery)?"