Stage Information for Chronic Lymphocytic Leukemia

After chronic lymphocytic leukemia (CLL) has been diagnosed, tests are done to find out whether the cancer has spread.

Staging is the process used to find out how far the cancer has spread. In CLL, the leukemia cells may spread from the blood and bone marrow to other parts of the body, such as the lymph nodes, liver, and spleen. It is important to know whether the leukemia cells have spread in order to plan the best treatment.

The following tests may be used to find out how far the cancer has spread:

• Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body, such as the lymph nodes.
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the neck, chest, abdomen, pelvis, and lymph nodes, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This test is used in patients with many swollen lymph nodes throughout the body. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. If a PET-CT scan is not available, a CT scan alone may be done.
• PET-CT scan: A procedure that combines the pictures from a positron emission tomography (PET) scan and a computed tomography (CT) scan. The PET and CT scans are done at the same time on the same machine. The pictures from both scans are combined to make a more detailed picture than either test would make by itself. A PET scan is a procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. This test is done in patients with fever, drenching night sweats, weight loss, or fast-growing lymph nodes to check whether CLL has become an aggressive form of lymphoma.

The following stages are used for CLL:

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 CLL 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, or there may be too few red blood cells.

CLL is described as asymptomatic, symptomatic or progressive, recurrent, or refractory.

• Asymptomatic CLL: The leukemia causes no or few symptoms.
• Symptomatic or progressive CLL: The leukemia has caused significant changes to blood counts or other serious symptoms.
• Recurrent CLL: The leukemia has recurred (come back) after a period of time in which the cancer could not be detected.
• Refractory CLL: The leukemia does not get better with treatment.