The Orcs and Castles and Neutrophils of Cancer

Life with cancer is tied directly to one's Absolute Neutrophil Count or ANC (not the African National Congress). They are a measurement of how robust a person (or your child's) immune system is.

Because I like analogies, and because I have boys, here is how I think of Counts. Your child's body is a stone castle with a mote and drawbridge and all that. His or her ANC is therefore the measurement of how thick the castle walls are. Your child's castle (or body) is under constant siege from orcs (germs as well as the cancer) who really want to get inside and mess the place up. So obviously the thicker the walls are, the better the chances is of keeping the orcs out. The trouble is that both the cancer and the chemo undermining your child's defenses. Bits of the castle’s fortification keep falling down, and the very skilled builders (white blood cells called neutrophils) that can repair the damage keep getting squashed under the rubble. More builders can be trained to help rebuilding the castle's defenses, but it takes time to train them. In other words, it takes time for the body to make new neutrophils to combat disease. When the walls are thin your child’s ANC is low, when they are higher the body is healthy.

Normal - 2,500 and 6,000

At Risk - 1000 and below

Understanding these numbers is a basic tool during treatment. Sometimes the castle is well defended, while at other times...not so much. Treatment can only happen when the walls are strong enough to handle friendly fire (or chemo). If it isn't then the large sections of walls could collapse. And that would be really bad.