Diagnosing CLL

Doctors need the results of various tests to determine if you have CLL. Getting a diagnosis can sometimes take a while.

It is important for your doctors to have as much information about your cancer as possible. This helps them to work out the stage of your cancer. The stage of the cancer will help your doctor decide which treatment is best for you.

At times, just about everyone will have to wait to have tests or to get the results. Many people begin to worry that the CLL will get worse during this time. CLL usually grows very slowly and this is not likely to happen. It always helps to ask your doctor or nurse how long your test results will take. If you have not heard anything a couple of weeks after your test, call your doctor's office or clinic to check if your results are back.

To confirm the presence of CLL and to determine the stage of your cancer, tests that examine the blood, bone marrow and lymph nodes may be performed. Some of the tests that may be required are:

  • Complete blood count (CBC) to verify the number of red blood cells, white blood cells, and platelets
  • Flow cytometry to detect the presence of leukemic cells
  • Bone marrow aspiration and biopsy to check for abnormal cells in the bone marrow
  • Molecular genetics using a technique called FISH (fluorescence in situ hybridization) or cytogenetics to look for genetic mutations within the CLL cells (which may be associated with prognosis)
  • Blood chemistry studies, to measure certain substances in the blood.

The results of these tests will help to assist you and your doctor to make decisions about your treatment. Some additional prognostic testing may be available only in specialized labs or may be performed only for research purposes. Currently, treatment decisions are usually based on clinical findings (symptoms, physical examination and blood tests).

   Prognostic Marker  Better Prognosis   Poorer Prognosis
Routine  Rai stage  0  3 and 4
 Lymphocyte doubling time   >12 months  >12 months
 CD38  Low  High
 Beta(2)-microglobulin  Low  High
Investigational   IgVH mutation  Mutated  Unmutated
 ZAP-70  Low  High
 Cytogenetics  del 13q  del 17q, del 11q