Surgery for Acute Lymphocytic Leukemia (ALL)

Surgery has a very limited role in the treatment of acute lymphocytic leukemia (ALL), also known as acute lymphoblastic leukemia.

Because leukemia cells are spread widely throughout the bone marrow and blood, it isn't possible to cure this type of cancer with surgery. Aside from a possible lymph node biopsy, surgery rarely has a role even in the diagnosis of ALL. (Diagnosis is typically done with a bone marrow aspiration and biopsy.)

The main role for surgery in ALL is to insert catheters (tubes) into the body to make it easier to give chemotherapy (chemo), which is the main treatment for most people with ALL.

• Note: This information is about treating acute lymphocytic leukemia (ALL) in adults. To learn about ALL in children, see Leukemia in Children.

Placement of a central venous catheter

Before chemo starts, surgery is often done to insert a small plastic tube into a large vein, usually in your chest. This tube is called a central venous catheter (CVC), central line, or venous access device (VAD). The end of the tube stays just under your skin or sticks out in your chest area or upper arm.

This might be done by a surgeon in an operating room or by a special type of radiologist.

The CVC is left in place during treatment (often for many months) to take blood samples and give intravenous (IV) drugs like chemo. This lowers the number of needle sticks you need during treatment.

If you have a CVC, it’s very important to learn how to care for it to prevent infection. Your cancer care team will teach you or a caregiver how to do this.

Placement of an Ommaya reservoir

Giving chemo directly into the fluid surrounding the brain and spinal cord (cerebrospinal fluid or CSF) is often a part of treatment for ALL. This is called intrathecal chemo.

In this treatment, the chemo medicines are given either through a lumbar puncture (spinal tap) or an Ommaya reservoir. You can learn more about this in Tests for ALL.

An Ommaya reservoir is a dome-like device attached to a catheter. It is put in place during a surgical procedure. The dome sits under the skin of your scalp, with the catheter going through a small hole in your skull and into one of the fluid-filled spaces (ventricles) in your brain.

Intrathecal chemo can be given by placing a needle through your skin and into the dome. The chemo goes through the catheter and into the CSF in the ventricle. From there, it circulates through the area around your brain and spinal cord.

An Ommaya reservoir allows you to get intrathecal chemo without repeated spinal taps. CSF can also be withdrawn from the Ommaya reservoir to check for leukemia cells and signs of infection.