Enlarged spleen after colon caner - Liver problem or cancer?

Hi, After chemotherapy with FOLFOX-4 (5FU, Leukovorin, oxaliplatin), you wife has had a progressive reduction in the platelet count (from 290000 to 69000 and now 62000. Also her WBC count is low (2400 in March). Ultrasound of the abdomen is fine, and so is the bone marrow. These are good signs, and indicate that cancer relapse is not the cause of these abnormal test results. Perhaps the enlarged spleen is the culprit, and is causing suppression of WBC and platelets. This is referred to as hypersplenism. The first step is to repeat the complete blood counts from a different laboratory. If it confirms low counts, then the next step is to examine a peripheral smear of blood to rule out megaloblastic anemia. This may be caused by poor nutrition during the months of cancer treatment. Serum Vitamin B12 and folate levels should be estimated. (However, megaloblastic anemia would have been picked up in the bone marrow examination). Chemotherapy drugs sometimes cause prolonged suppression of blood elements in some people. One suspected mechanism is that they affect early stem cell precursors. However, this usually resolves in a few weeks. Your wife must see a hematologist or an internist for this issue. She must also be under surveillance by her oncologist and undergo regular CEA tests. What is her current Hemoglobin value?

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Wed 02, Apr 2008 09:34pm

Thanks a lot for your quick response. Her oncologist is a hematologist as well and we've done all blood related tests(B12, folate level,hepatitis,thyroid,artritis) and everything is normal.The only thing the bone marrow and regular blood test both showed low iron(16). After she started to take iron pills, the iron level is 25.In February her blood test showed anemia a little bit(11.4). After taking the iron pills, the Hemoglobin was 12.2 in March. Once again, oncologist is saying it is not related to cancer or blood. We went to GI doctor and he said that ther is nothing wrong with her liver. To test liver, ultra sound was done and the blood flow between spleen and liver. Everything is normal. Also, cat scan was done and did not show any abnormalities with liver. This happend right after the last session of the chemo. She is experiencing the following symptoms: numbness in the fingers, joint pain. Joint pain is worse in the morning that she has difficulties walking. Then after some time it is getting better. Also, there is joint pain in the albows. Again, all blood tests for artritis look normal. The oncologist said that the next step should be liver biopsy, but it is dangerous to do because of low platelets. Thanks a lot.

Thu 03, Apr 2008 06:01am

Hi Alex, I would put off doing a liver biopsy at this stage. Liver appears fine on CT scan, ultrasound, and the liver function tests are all normal. Diffuse involvement of liver by infectious organisms like fungus or tuberculosis is a rare possibility. Recent reports have implicated the role of chemotherapy-induced damage of bone marrow micro-environment consisting of mesenchymal elements, stem cell adhesion molecules, and MMPs (matrix metalloproteinases) in the genesis of prolonged neutropenia and thrombocytopenia.

Enlarged spleen after colon caner - Liver problem or cancer?

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