Chronic Lymphocytic Leukemia (CLL) diagnosis

If your healthcare provider believes you may have Chronic Lymphocytic Leukemia (CLL), you will need certain exams and tests to be sure.

You should expect to be asked questions about your health history, your symptoms, risk factors, and family history of disease. Understanding your background will help your provider make a diagnosis.

The first step is for the doctor to take a complete medical history to check for risk factors and symptoms. Following your physical exam, you may have one of the following tests:

  • Flow Cytometry. Blood tests like this can be used to see if the lymphocytes in a sample of blood contain CLL cells. It uses a machine that looks for certain substances on or in cells to identify what types of cells they are. Flow cytometry can also be used to look for CLL cells in bone marrow or other fluids.
  • Bone Marrow Tests. Testing bone marrow can help tell how advanced your case of CLL is. As a result, bone marrow tests are often done before beginning treatment. They might also be repeated during or after treatment to examine the progress being made.  

There are four stages of CLL that a patient may be diagnosed with. Staging is the process that shows if cancer has spread in the blood and bone marrow. These steps will help determine your particular stage of CLL. Learn more about each of the four stages below.

Stage 0

  • In stage 0 CLL, there are too many lymphocytes in the blood, but there are no other signs or symptoms of leukemia. Stage 0 chronic lymphocytic leukemia is indolent (slow-growing).

Stage I

  • In stage I CLL, there are too many lymphocytes in the blood and the lymph nodes are larger than normal.

Stage II

  • In stage II CLL, there are too many lymphocytes in the blood, the liver or spleen is larger than normal, and the lymph nodes may be larger than normal.

Stage III

  • In stage III CLL, there are too many lymphocytes in the blood and there are too few red blood cells. The lymph nodes, liver, or spleen may be larger than normal.

Stage IV

  • In stage IV CLL, there are too many lymphocytes in the blood and too few platelets. The lymph nodes, liver, or spleen may be larger than normal and there may be too few red blood cells.

For more information on stages of CLL, visit the National Cancer Institute (NCI) CLL treatment webpage.

Many people with chronic lymphocytic leukemia have no early symptoms. Those who do develop signs and symptoms may experience:

  • Enlarged, but painless, lymph nodes.
  • Fatigue.
  • Fever.
  • Pain in the upper left portion of the abdomen, which may be caused by an enlarged spleen.
  • Night sweats.
  • Weight loss.
  • Frequent infections.

Factors that may increase the risk of chronic lymphocytic leukemia include:

  • Your age. This disease occurs most often in older adults. On average, people diagnosed with chronic lymphocytic leukemia are in their 70s.
  • Your race. White males are more likely to develop chronic lymphocytic leukemia than are people of other races.
  • Family history of blood and bone marrow cancers. A family history of chronic lymphocytic leukemia or other blood and bone marrow cancers may increase your risk.
  • Exposure to chemicals. Certain herbicides and insecticides, including Agent Orange used during the Vietnam War, have been linked to an increased risk of chronic lymphocytic leukemia.

Make an appointment with your doctor if you have any persistent signs and symptoms that worry you.

For more information on diagnosis, treatment and more of chronic lymphocytic leukemia, visit our CLL information pages below.

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