Lesion on spleen

[Mrs. Bob Loblaw]

My husband had his surgery around June 2010. He had stage 1 seminoma TC and there was no sign of invasion (I'm doing this from memory - our records are at home and I'm at work right now, so I can't remember all the correct terminology). We chose surveillance and just got the results of his last cat scan. He has a lesion on his spleen that they think may have grown since his last cat scan. We were never told about the lesion before now. They want my husband to get an MRI as soon as he can, but we were told not to worry, it's probably nothing. Does TC spread to the spleen before other areas? This doctor also doesn't believe in chest x-rays, so we've only had cat scans done so far.

[CW406]

The spleen is not in the normal path of spread for TC, especially seminoma. Seminoma generally spreads to the para-aortic lymph nodes first and then on from there to various places. But it usually becomes really detectable in the nodes well before this happens. Of course there are exceptions; that's why you see doctors writing case studies about odd cases. Most likely, though, I would think this to be unrelated.

Does your doctor not believe in screening of the chest at all, or does he use chest CTs? If it's the latter, those are ok, since CTs are just a bunch of X-rays (although he is likely getting more radiation than he needs). If it's the former, I'd probably get a new doctor.

[Nut of Mordor]

Radiologist found a 5mm lesion on my spleen during my first CT, I have been told it's a cyst.
I'm a seminoma 1A too.

[K&R]

Does your doctor not believe in screening of the chest at all, or does he use chest CTs? If it's the latter, those are ok, since CTs are just a bunch of X-rays (although he is likely getting more radiation than he needs). If it's the former, I'd probably get a new doctor.

The updated (2011) NCCN surveillance for seminoma (or seminoma treated with carbo) changes chest x-ray from every other visit to "as clinically indicated". Seems like there is little risk for it to jump to the chest without being detectable in the abdomen (as opposed to some non-seminomas).

It would be unusual for it to jump to the spleen without any lymph node involvement, but that is why we all do surveillance. Hopefully the MRI will help resolve the spleen issue. Good luck.

Kevin