Chronic Lymphocytic Leukemia

Your healthcare provider will ask about your symptoms. They’ll do a physical examination, and may order the following tests:

• Complete blood count (CBC) with differential: A complete blood count measures the number of red blood cells, white blood cells and platelets in your blood. It also assesses how much hemoglobin (protein that carries oxygen) your red blood cells have.
• Peripheral blood smear: A medical pathologist examines your blood cells under a microscope to look for cancerous blood cells.
• Flow cytometry: Providers use this lab test to learn more about your blood cells. In CLL, they use flow cytometry to determine if your white blood cells carry CLL cells.
• Genetic tests: Pathologists use tests such as fluorescent in situ hybridization (FISH) and immunoglobulin heavy chain (IGHV) to examine your chromosomes and genes. Understanding how chromosomes and genes mutated or changed helps providers determine how to treat CLL.

Stages of chronic lymphocytic leukemia

Healthcare providers use cancer staging systems to develop treatment plans and prognoses (expected outcome). Providers stage CLL with two similar staging systems. The Rai staging system categorizes CLL by the likelihood the condition will get worse and require treatment. The Binet system stages CLL by how much the condition has spread throughout your body.

Rai staging system

The Rai staging system categories are:

• Low risk (formerly known as Rai stage 0): You have lymphocytosis and abnormal white blood cells in your blood and/or bone marrow.
• Intermediate risk (formerly known as Rai stage I or stage II): You have lymphocytosis, enlarged lymph nodes and an enlarged spleen and/or liver.
• High risk (formerly known as Rai Stage III): You have anemia or thrombocytopenia.

Binet staging system

The Binet staging system uses information about your blood cell and platelet count and the number of areas in your body with swollen lymph nodes. Binet staging system categories are:

• Stage A: You don’t have anemia (low red blood cells) or low platelet levels, but you have swollen lymph nodes in at least two areas in your body. For example, you have swollen lymph nodes in your neck and groin.
• Stage B: There are swollen lymph nodes in three areas of your body, liver or spleen, but you don’t have anemia and your platelet levels are normal.
• Stage C: You have anemia, as well as swollen lymph nodes, in three or more areas of your body.

Some people with cancer feel intimidated or unnerved by systems that seem to reduce their condition to a formula of numbers and letters. Your providers understand why you may feel this way. If you’re confused or concerned by what you’re hearing, ask your provider to explain how the cancer staging system works in your situation.