Surgery has a very limited role in the treatment of acute lymphocytic leukemia (ALL). Because leukemia cells spread widely throughout the bone marrow and to many other organs through the blood, it is not possible to cure this type of cancer by surgery. Aside from a possible lymph node biopsy, surgery rarely has any role even in the diagnosis of ALL, since a bone marrow aspirate and biopsy can usually diagnose leukemia.
Often before chemotherapy (chemo) is about to start, surgery is needed to insert a small plastic tube, called a central venous catheter or venous access device (VAD), into a large vein. The end of the tube stays just under the skin or sticks out in the chest area or upper arm. The VAD is left in place during treatment to give intravenous (IV) drugs such as chemo and to take blood samples. This lowers the number of needle sticks needed during treatment. It is very important to learn how to care for the device to keep it from getting infected.
Giving chemo directly into the fluid that surrounds the brain and spinal cord (cerebrospinal fluid or CSF) is often a part of the treatment of ALL. In this treatment, called intrathecal chemo, the medicines can be given through a lumbar puncture (spinal tap) or through an Ommaya reservoir. An Ommaya reservoir is a dome-like device attached to a catheter. The dome part sits under the skin of the scalp, with the catheter going through a hole in the skull and into one of the cavities of the brain (a ventricle). Intrathecal chemo can be given by placing a needle through the skin and into the dome. The chemo goes through the catheter and into the CSF in the ventricle. The CSF in the ventricle circulates through the other ventricles and into the area around the brain and spinal cord. An Ommaya reservoir allows you to get intrathecal chemo without having to get repeated spinal taps. CSF can also be withdrawn from the Ommaya reservoir to check for leukemia cells and signs of infection (instead of a spinal tap).
Last Revised: 02/18/2016