Ugh, spleen!

I had an MRI this month, and an appointment with my oncologist. The good news is that my tumors continue to stay “stable” and don’t show any growth of note. Hip hip, hooray!!! He thinks the monthly Lanreotide shots have been doing their job, so I’ll continue those indefinitely. As I’ve said before, somatostatin analog shots might be a life-long treatment for me. He wants me to have another scan in six months, a.k.a. February, and this time it will be a combo DOTATATE/MRI. Fingers crossed the tumors continue to stay the same size they are now!!

He and I also talked about my abdominal pain. I’m now up to half a hydrocodone four times a day. It definitely helps, and I’m lucky to have a pain management medication that does. Most of the pain I feel is from my enlarged spleen.

Ah, the spleen. My poor spleen. Currently it’s 16cm long, but it’s been huge since 2020. One doctor even called it “enormous”! I don’t know exactly how big it was before, but I’ve been told it’s approximately three times larger than it should be. Here is a tracking chart:

If PRRT is on the table for me next year, my oncologist is concerned about my low platelet count. I have low platelets because I have an enlarged spleen. The relationship between the two is very interesting!

My oncologist suggested that next year he may recommend a splenic embolization (part of the spleen would be deliberately killed off) or even a full splenectomy (the spleen would be removed), in order to increase my platelet count. However, any surgery comes with risks, and we will have to consider very carefully the pros and cons. However, right now I can say with certainty that it sure would be nice not to have spleen pain all the time…

As readers may recall (relevant posts here, here, and here), despite a battery of tests, no doctor has yet figured out why my spleen is enlarged or why I’ve had two splenic infarcts. They all end up saying “it probably has something to do with your neuroendocrine cancer.” I don’t think they are wrong, but it is still stressful that there is no firm answer.

Footnote: Some of my pain is probably also from the cluster of tumors that are at the top of my liver. Fun fact that I learned today: although livers themselves don’t have pain receptors, the “capsule” that surrounds the liver does, so that is likely what I’m feeling. I do have other pains in other general areas of my abdomen, but other than guesses like “maybe it’s your GI track not behaving” or “maybe it’s scar tissue from your surgeries,” it’s still a mystery.