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Other PLAIN summaries
- Asymptomatic coronary artery disease
- Bone problems
- Cancer-related fatigue
- Central precocious puberty – CPP
- Chronic pain
- Craniofacial growth problems
- Dental and oral problems
- Dyslipidemia
- Eye problems
- Gastro-intestinal problems
- Hair loss
- Health promotion
- Hearing problems
- Heart problems
- Higher risk groups
- HP axis problems
- Hypertension
- Impaired glucose metabolism and diabetes
- Kidney problems
- Liver problems
- Lower urinary tract problems
- Lung problems
- Male fertility problems, testosterone deficiency and sexual dysfunction
- Mental health problems
- Neurocognitive problems
- Obstetric problems
- Overweight and obesity
- Peripheral neuropathy
- Premature ovarian insufficiency
- Psychosocial problems
- Spine scoliosis and kyphosis
- Spleen problems
- Stroke
- Subsequent neoplasms:
- Thyroid problems
SPLEEN PROBLEMS
This page is part of the PanCare PLAIN summaries about late effects and recommendations for long-term follow-up care for survivors of childhood, adolescent, and young adult cancer. Click here, for more information on the PLAIN summaries.
On this page you can find:
This PLAIN summary is based on the PanCareFollowUp guideline about “Spleen problems” [1], which is based on the consensus of different national guidelines.
PLAIN version 2.1: 27/05/2024
Spleen problems (reduced spleen function)
The spleen is an organ in the upper abdomen, just behind the stomach. The most important function of the spleen is to store white blood cells before they are released into the bloodstream. White blood cells are needed to fight infections.
Sometimes problems can occur with the spleen and weaken the immune system. This may lead to frequent infections. In particular, infections caused by bacteria (for example Pneumococcus, Meningococcus, and Haemophilus Influenzae type B) may occur more often.
The spleen
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Hover over the numbers in the figure for more information.
Am I at higher risk of reduced spleen function?
Anyone, including people who have never had cancer treatment, may develop reduced spleen function. However, there are some cancer treatments that may increase the risk of having reduced spleen function later in life.
The following treatments can increase the risk of reduced spleen function:
- Surgery that involves removal of the spleen
- Radiotherapy to the spleen or an area that includes the spleen (10 Gy or more)
- Stem cell transplantation with stem cells from a donor (allogeneic) with or without total body irradiation
- Bone marrow transplantation with your own bone marrow (autologous) together with total body irradiation
You can find out if you have received any of these treatments by looking at your treatment summary. If you do not have a treatment summary or if you have any questions, do contact your treating hospital.
If you experience reduced spleen function, it does not always mean that this is caused by your cancer treatment. Reduced spleen function may have other causes.
Stem cell transplantation
Stem cell transplantation means that blood stem cells are taken out of the body of a person and transplanted back into the same person (autologous) or to another person (allogeneic).
This procedure is often used to treat diseases such as leukaemia and lymphoma, and some solid tumours (such as neuroblastoma) as well as certain immune system and genetic disorders.
There are different types of stem cell transplants, including:
- Autologous Transplant: Uses the patient’s own stem cells, which are harvested before treatments like chemotherapy or radiation and then returned to the body to help recover.
- Allogeneic Transplant: Uses stem cells from a donor. The donor can be a relative (often a sibling) or someone unrelated with a matching tissue type.
The blood stem cells can be harvested in different ways. They can either be taken out of the blood stream (peripheral blood stem cell transplantation) or out of the bone marrow (bone marrow transplantation).
During the transplantation process, the patient often undergoes a treatment to kill the diseased bone marrow cells before receiving the new stem cells through an intravenous line, similar to a blood transfusion. After the transplant, it takes time for the new stem cells to grow and start producing healthy blood cells, during which the patient needs close medical care to prevent and manage potential complications, such as infections or graft-versus-host disease (in case of allogeneic transplants).
Other causes
Bone marrow transplantation
Blood stem cells are special cells in the bone marrow that the body can use to make blood cells. Blood cells are a group of cells that include white blood cells, red blood cells and platelets. During their development, they enter the blood vessel system.
During a bone marrow transplant a mixture of these cells is transplanted into the recipient of the transplant. The mixture contains a large amount of blood stem cells and mature immune cells. As with a blood transfusion, this is injected into a vein of the recipient. The stem cells enter the bone marrow with the blood, settle there and begin to form new blood cells.
There are two different types of stem cell transplantation. In an allogeneic blood stem cell transplant, the stem cells are donated by another person. Normally, high-dose chemotherapy, sometimes in combination with radiation, is given before the transplantation. This not only kills the cancer cells, but also the healthy bone marrow and immune cells. A transplantation with healthy blood stem cells is therefore necessary afterwards. These transplanted blood stem cells are then used to form new blood cells in the bone marrow. However, it takes a few weeks for new immune cells to form. Mature immune cells from the donor must therefore also be transplanted. They can directly fight any remaining cancer cells and infections.
In an autologous blood stem cell transplant, the patient’s own blood stem cells are reimplanted. Here, blood stem cells and the patient’s own immune cells are collected from the patient’s blood and frozen before chemotherapy. After high-dose chemotherapy, the transplant is returned to the patient’s own blood. In the bone marrow, the blood stem cells begin to form blood cells again. Together with the blood stem cells, the patient’s own immune cells are also returned after such therapy. They may then act against any remaining cancer cells and possible infections.
Radiotherapy
Your treatment summary can tell you which areas of your body were irradiated. If you do not have a treatment summary or if you don’t understand what is written about the radiotherapy you received, do contact your treating hospital.
Radiotherapy is a treatment for cancer which uses high-energy radiation to destroy cancer cells and to shrink tumours. The radiation comes from a machine outside the body (external beam radiotherapy) or occasionally from radioactive material that is placed in the body near cancer cells (intracavitary or interstitial radiotherapy). The aim of radiotherapy is to treat only one area of the body, around and near the cancer or where the cancer was before it was removed by surgery and as far as possible to protect unaffected areas. For example, if you have cancer in your lung, you will have radiation only to your chest, not to your whole body.
External beam radiotherapy is painless and takes only a few minutes. It is given once or occasionally twice a day often for several weeks. A radiation beam is like an invisible light beam. The machines which produce the radiation beam can be moved so that the beam enters the body from different directions, ‘spotlighting’ on the area to be treated. This means that the tumour is given a high dose whilst normal areas get either a lower or no dose at all.
Since the early 1980’s computers and other technical advances have improved radiotherapy. Before this there were not many ways to protect normal tissues which were in the path of a radiation beam. Even now, whilst modern techniques allow doctors to target the cancer cells more precisely than older techniques, healthy cells may still get damaged. This can result in some of the late effects covered in the PLAIN summaries. It will help you and your follow up specialist to know what long term effects there might be after your radiotherapy if you and they have your treatment summary.
Your treatment summary can tell you which areas of your body were irradiated. If you do not have a treatment summary or if you don’t understand what is written about the radiotherapy you received, please contact your treating hospital.
What are the symptoms and signs of reduced spleen function?
There are symptoms and signs that can tell you if you might have a reduced spleen function. You might not have these symptoms and signs at the moment, but it is important to be aware of them in case they may develop in the future.
A common sign of reduced spleen function is frequent bacterial infections. Symptoms and signs of infections are:
- Fever (38.3 °C or higher)
- Severe bacterial infections may also cause very high fever (39.5 °C or higher) or hypothermia (35 °C or lower), chills and/or tremors, and drowsiness or sleepiness
If you have been experiencing frequent bacterial infections, please contact your general practitioner or follow-up care specialist.
Symptoms and signs
I am at higher risk of reduced spleen function. What tests should I have and when?
If you are at higher risk of spleen problems, regular testing is not necessary.
What happens if I have reduced spleen function?
If you have reduced spleen function, it is important to know about vaccinations and (prophylactic) antibiotics. Both of these things can reduce the frequency and severity of infections caused by bacteria (for example Pneumococcus, Meningococcus, and Haemophilus Influenzae type B).
Additionally, you may need to have travel vaccines and protective anti-malarial medications if you are travelling to an area where these infections are present.
Please ask your general practitioner or follow-up care specialist whether you need vaccinations or protective antibiotics.
Prophylactic
What happens if I experience symptoms and signs of reduced spleen function?
If you have reduced spleen function, it is important to see a doctor urgently when you have:
- a fever (38.3 °C or higher)
- symptoms and/or signs of an infection
- been bitten by an animal or human and the skin has been broken
The doctor may then decide to:
- Do a physical exam
- Do blood tests including a blood count (to look at the effect of the infection) and a blood culture test (to look for bacteria present in the bloodstream)
It may take a while before the results of the blood culture test are ready. However, in the meantime, the doctor may prescribe you antibiotics whilst waiting for the results.
To prevent infections from occurring or worsening in the future, prophylactic antibiotics may be needed.
What else can I do?
Experiencing spleen function can be difficult. Talking to friends and family can be helpful as well as specialist counselling and/or contact with support groups, such as patient organisations. For more information on taking care of your mental health, please read: Mental health problems.
If you have reduced spleen function, you may want to consider wearing a medical bracelet or carrying a patient card. In addition, if you plan to travel to countries with malaria, it is important to seek advice from your general practitioner or follow-up care specialist first. You may need travel vaccinations or medication to protect you against malaria.
Although it may not influence spleen problems, it is still important to live a healthy lifestyle. Taking care of your mental health may be beneficial; even small changes to your lifestyle can have a positive impact on both your physical and mental health. For more information on taking up a healthier lifestyle, please read: Health promotion.
It is important that you are aware of the possibility of developing spleen problems and that you know the symptoms and signs. It is also important that you know the symptoms and signs of infections. If you have any further questions or if the information in this brochure concerns you, please contact your general practitioner or follow-up care specialist.
Healthy lifestyle
- Having a healthy diet
- Drinking less (or no) alcohol
- Exercising regularly
- Quitting smoking (if you smoke)
Your follow-up care specialist or general practitioner may give you additional advice tailored to your individual situation for maintaining a healthy lifestyle. For more information on taking up a healthier lifestyle, please read: Health promotion.
Where can I find more information?
You may find more information about reduced spleen function online. However, it is important to be aware that this information is not always up to date or accurate.
Some sources of further information are:
- Together: Here you can find more information about spleen problems in general
On this website, you can also find more information related to this topic:
Please note
This PLAIN summary is based on the PanCareFollowUp guideline about “Spleen problems” [1], which is based on the consensus of different national guidelines.
While the PanCare PLAIN information group strives to provide accurate and complete information that is up-to-date as of the date of publication, you can check with your general practitioner or follow-up care specialist if this summary reflects the most up-to-date information available and whether it is relevant for you.
Please do not rely solely on this information. It is best to also seek the advice of a qualified medical practitioner if you have questions regarding a specific medical condition, disease, diagnosis or symptom.
No warranty or representation, expressed or implied, is made concerning the accuracy, reliability, completeness, relevance, or timeliness of this information. PanCare has produced the English version and PanCare is not responsible for the translated versions of this summary.
The PanCare materials are free to use for anyone aiming to inform about late effects and long-term survivorship care. However, no financial advantage may be achieved. All communication should reference PanCare and link to the PanCare website.
[1] van Kalsbeek, R. et al. (2021) European PANCAREFOLLOWUP recommendations for surveillance of late effects of childhood, adolescent, and Young Adult Cancer, European journal of cancer. Available at: https://www.ejcancer.com/article/S0959-8049(21)00368-3/fulltext