Malignant pathologies

The spleen can be the site of malignancies which, like those in the rest of the body, can be divided into primary malignancies and secondary malignancies (or metastases). Among the first we have angiosarcomas, which originate as degeneration of the cells of the blood vessels; lymphosarcomas, which derive from the cells of the lymphatic vessels; lymphomas, which are the most frequent and originate from cells of the immune system of the spleen or from lymph nodes disseminated throughout the body, can form large abdominal masses that involve the spleen and nearby organs; and leukemia, tumors that originate in the cells of the immune system that cause alterations in the blood cells and that more rarely affect the spleen.


Regarding secondary malignant tumors, however, the tumors that can most frequently cause metastasis in the spleen are tumors of the lung, breast, stomach, prostate, liver, and melanoma.


The symptoms of a tumor involving the spleen can be very generic and, in some cases, resemble those of a normal cold (due to reduced ability to fight infection).


One of the symptoms that most clearly indicates that something is wrong at the splenic level is an enlarged spleen (splenomegaly), which, however, is not necessarily associated with the presence of a tumor. Other symptoms that may represent an alarm signal are: abdominal pain, especially in the upper abdomen, bone or joint pain, easy bleeding, tiredness, fever and chills, frequent infections, night sweats, swollen lymph nodes or weight loss. All these symptoms can depend on many pathologies, not necessarily of an oncological type, and to establish the cause of each one it is necessary to consult a doctor. In some cases, the enlarged spleen can spontaneously rupture.


In the case of symptoms that may suggest a tumor of the spleen, the doctor begins with a precise anamnesis (gathers information about the patient's medical history) and asks about the symptoms and risk factors (work in contact with dangerous substances, family history of lymphomas or leukemias, etc.).

A simple palpation of the abdomen can indicate if the spleen is enlarged, while a blood test can detect any problems with the blood cells, including anemia (low levels of red blood cells). The marrow examination Bone can also indicate the presence of leukemia or lymphoma. Imaging diagnostic techniques are widely used for the definitive diagnosis of spleen cancer: ultrasound is capable of verifying the presence of abnormalities in the structure of the organ and sometimes also distinguishing the different types of pathology present, while CT or MRI are used to determine if and how far the tumor has spread to other parts of the body. Biopsy , the main diagnostic tool for many tumors, is difficult to perform on the spleen because the risk of bleeding is so high . Cytologic examination of cell samples taken with the needle aspiration technique is preferred to histologic (tissue) analysis.


Lymphomas are classified into four stages of increasing severity, indicated by Roman numerals I through IV, using a staging system called the Lugano classification. The classification is based on the number of locations and sites affected by the lymphoma. If the spleen is involved, the Roman numeral may be followed by the letter S (in English spleen = spleen).


Sarcomas are also classified into four stages, from I to IV, but for staging the TNM system is used , where T indicates the extent of the tumor, N the involvement of the lymph nodes, and M the presence of metastases. Splenic angiosarcomas are aggressive tumors that tend to metastasize to lymph nodes and other organs (liver, lung, bone). The patients who have the best prognosis are those whose cancer is diagnosed early and is surgically removed before the spleen ruptures.


The choice of the most appropriate treatment for cancer of the spleen depends mainly on the type of disease (lymphoma, sarcoma or other) and its extent, but also on the general state of health of the patient.


Surgery is undoubtedly one of the main treatments for spleen cancer: splenectomy allows the total removal of the organ, without which it is possible to continue living normally (except for minor immunological and lymphatic problems).


Radiation therapy and chemotherapy also play a role in the treatment of tumors of the spleen. Both the radiotherapy protocol (radiation dose, number of sessions) and the type of drugs chosen depend on the type of tumor and both can be administered in adjuvant (after surgery, to eliminate the remaining tumor cells) or neoadjuvant (before surgery). surgery, to reduce the size of the tumor).


New treatment possibilities may come from molecular target therapies, in which drugs are used that target specific molecules in tumor cells, such as some receptors or proteins involved in the formation of new vessels, or from immunotherapy, capable of to stimulate the immune system against the tumor. .


In some specific cases, it is possible to opt for a "conservative" attitude of expectant management for spleen cancer, which consists of not directly intervening with surgery, chemotherapy or radiotherapy, but rather keeping the disease under control and intervening only at the most appropriate moment.