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Surgery for hairy cell leukaemia

Men and women discussing hairy cell leukaemia

This page is about surgery for hairy cell leukaemia (HCL). You can find information about

 

A quick guide to what's on this page

Surgery for hairy cell leukaemia

Doctors don't use surgery to treat hairy cell leukaemia (HCL) very often. But some people with HCL need an operation to remove their spleen. The spleen is quite a large organ that filters the blood, and destroys and recycles worn out red blood cells. It also gets rid of bacteria and dead tissues to prevent infection. In HCL, the spleen sometimes swells up and causes problems. An operation to remove the spleen is called a splenectomy.

Before your operation

Before your operation your surgeon will explain what will happen during the operation. A physiotherapist will come and explain the breathing and leg exercises you will need to do after your operation.

To help prevent infection in the future, you will need to have some vaccinations a couple of weeks before the operation. This is because the spleen is part of your immune system. Without a spleen you will be more at risk of infection.

Recovering from your operation

When you wake up, you will probably have some tubes in place. You will have a drip to give you fluids and drainage tubes from your wound to help it heal. You can usually go home after a week or so, or sooner if you have had keyhole surgery.

If you do not have a spleen, you are at risk of serious infection. You will have to take antibiotics for the rest of your life to help avoid infection. You should carry a card saying you have no spleen, in case of medical emergencies. If you are planning to travel abroad, you may need extra vaccinations.

 

CR PDF Icon You can view and print the quick guides for all the pages in the Treating hairy cell leukaemia section.

 

 

Treating HCL with surgery

Doctors don't use surgery to treat hairy cell leukaemia very often. This is because leukaemia is a disease that affects the whole body. Doctors call this a systemic disease. So the best treatment is one that treats the whole body such as chemotherapy. But some people need an operation to remove the spleen.

 

Removing the spleen

The spleen is quite a large organ. Its normal job is to filter the blood, and destroy and recycle worn out red blood cells. The spleen also gets rid of bacteria and dead tissue to prevent infection. In hairy cell leukaemia, it sometimes swells up and causes problems. This is because it gets so clogged up with abnormal cells that it doesn't work properly. And the enlarged spleen may destroy too many red blood cells and platelets. If your red blood cell count is too low, you have anaemia, making you tired and breathless. Low platelets cause bleeding problems because the platelets are essential for normal blood clotting.

Diagram showing the position of the spleen

An operation to remove the spleen is called a splenectomy. Your doctor may suggest you have a splenectomy if your spleen

  • Is so large it is causing discomfort or pain
  • Is destroying too many red blood cells or platelets
  • Has not shrunk after chemotherapy

Your doctor may not give you any other treatment for some months after having your spleen out. They will keep a close eye on your blood counts. If the number of leukaemia cells in your blood starts to go up, you will need to have chemotherapy.

About your operation

Before your operation, when you sign the form agreeing to surgery, your surgeon will explain what will happen during the operation. A physiotherapist will come and explain the breathing and leg exercises you will need to do after your operation. These exercises will help you recover and help prevent chest infection or blood clots (deep vein thrombosis or DVT).

To help prevent infection in the future, you will need to have some vaccinations a couple of weeks before the operation. This is because the spleen is part of your immune system and helps to fight infection. So, without a spleen you will be more at risk of infection.

You may have surgery with a laparoscope instead of the usual open surgery to remove your spleen. This is known as keyhole surgery. A laparoscope is a flexible tube filled with optical fibres. Your surgeon makes two small cuts and feeds the laparoscope through. They will perform the operation using the tube. With laparoscopic surgery, you will recover more quickly and be able to go home sooner than you would after major surgery. But if your spleen is too large for keyhole surgery, you may have to have conventional open surgery instead. 

Recovering from your operation

When you wake up, you will probably find you have some tubes in place. These are

  • A drip (intravenous infusion) to give you fluids
  • Drainage tubes from your wound to help it heal

The drip can come out as soon as you can start eating and drinking again. This may take a couple of days. Your doctor will listen to your tummy (abdomen) with a stethoscope. As soon as the doctor can hear your bowel working again, you will be able to start taking sips of water. Gradually you will work up to eating and drinking normally.

The drainage tubes connect to containers that collect fluid draining from the wound. Once there is no more fluid draining, your nurse will take the tubes out. This is normally after a couple of days. It only takes a minute to gently pull the tubes out. You may get a twinge or two, but it doesn't generally hurt.

The nurses will help you to get up and move around gently as soon as possible. This helps you to get better and makes complications, such as chest infections or blood clots, much less likely.

Below is a short video showing breathing and circulation exercises after surgery. Click on the arrow to watch it.
 


 

View a transcript of the video showing breathing and circulation exercises after surgery (this opens in a new window).

You can usually go home a week or so after this type of surgery. If you have had laparoscopic surgery you will be able to go home sooner – maybe after only a couple of days. Your stitches will need to come out about two weeks after your operation. You may go back to the hospital to have this done, or go to your GP surgery.

Before you leave the hospital, your nurse will give you an appointment to go back and see your surgeon. This is usually about 6 weeks later. The usual advice after abdominal surgery is to wait until after your follow up appointment before you go back to work or start driving again.

We now know that exercise is good for you when you are recovering from surgery. But it is important not to overdo it. Start by walking slowly for short distances and remember to include the distance you'll have to walk back. Gradually build up your tolerance over days and weeks. If you do too much one day, you will set yourself back the next.

Once you have had your splenectomy, you should carry a card saying you have no spleen, in case of medical emergencies. If you do not have a spleen you are at risk of serious infection. You will have to take antibiotics for the rest of your life to avoid infections. If you are planning to travel abroad, you need to talk to your doctor about health precautions. They may advise extra vaccinations because you have no spleen.

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Updated: 14 April 2015