What Are the Stages of Chronic Lymphocytic Leukemia?

Chronic lymphocytic leukemia is a cancer of the blood and bone marrow.

Staging is the process used to find out whether and how far cancer has spread in the body. Doctors can determine how advanced or serious a cancer is in terms of the size and its metastasis through staging. It is important to know the stage of the disease to plan the best treatment. The stages for chronic lymphocytic leukemia are as follows:

Stage 0:

• Stage 0 chronic lymphocytic leukemia (CLL) is indolent (slow growing).
• There are too many lymphocytes in the blood, but there are no other signs or symptoms of leukemia.
• Lymphocytes are white blood cells that are also one of the body's main types of immune cells. They are produced in the bone marrow and found in the blood and lymph tissue.

Stage I:

• There are too many lymphocytes in the blood, and the lymph nodes are larger than normal.
• Lymph nodes are small structures that work as filters for harmful substances such as bacteria. They contain the immune cells that can help fight infection by attacking and destroying germs that are carried in through the lymph fluid. There are hundreds of lymph nodes throughout the body.

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.
• Recurrent CLL: It is a type of cancer that has recurred (come back) usually after a period or during which the cancer could not be detected.
• Refractory CLL: It is cancer that does not get better with treatment.

Chronic lymphocytic leukemia (CLL) is a blood and bone marrow cancer in which the bone marrow makes too many abnormal lymphocytes. There are two types of lymphocytes: B and T lymphocytes. These white blood cells are an important part of the immune system; they help to fight infection. More than 90% of CLL cases affect the B cells. CLL is one of the most common types of cancer in adults and is typically a slow-progressing disease. It is usually diagnosed when a person is in their middle age or older, and it is rarely diagnosed in children. CLL may affect the red blood cells, white blood cells, and platelets. Because CLL develops slowly, many people don't exhibit any symptoms, particularly in the early stages. The disease can be diagnosed during a routine blood test. Symptoms arise from an increasing number of abnormal blood cells in the bone marrow and blood and a decreasing number of normal blood cells. Possible signs and symptoms may include the following:

• Anemia due to the lack of red cells -- This causes persistent tiredness, dizziness, pallor, or shortness of breath when physically active.
• Increased or unexplained bleeding or bruising and/or the appearance of red or purple flat pinhead-sized purple spots on the skin, especially on the legs initially -- These are due to an extremely low platelet count.
• Frequent or repeated infections and slow healing due to the lack of normal white blood cells
• Pain or discomfort under the ribs on the left side due to an enlarged spleen
• Painless swelling of the lymph nodes (glands) in your neck, under your arms, or in your groin -- This is usually a result of lymphocytes accumulating in these tissues.
• Excessive sweating at night
• Unintentional weight loss

Patients with chronic lymphocytic leukemia (CLL) may opt for standard (the currently used treatment) or new treatments.

Five types of standard treatment are used:

1. Watchful waiting: This is also called observation. During this time, medical professionals treat problems caused by the disease, such as infection.
2. Radiation therapy: It uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing.
3. Chemotherapy: It uses drugs to stop the growth of cancer cells; it either kills the cells or stops them from dividing.
4. Surgery: Splenectomy is surgery to remove the spleen, which is usually recommended for CLL.
5. Targeted therapy: It uses drugs or other substances to identify and attack specific cancer cells without harming normal cells.

New types of treatment are being tested in clinical trials. They are as follows:

• Chemotherapy with stem cell transplant: It is a method of giving chemotherapy and replacing the blood-forming cells destroyed by cancer treatment. The doctor removes the stem cells (immature blood cells) from the blood or bone marrow of the patient or donor and freezes and stores them. After the chemotherapy is completed, the doctor thaws the stored stem cells and gives them back to the patient through an infusion. These re-infused stem cells grow into (and restore) the body's blood cells.
• Immunotherapy: This treatment uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or biologic therapy.