In this type of cancer, the disorder starts from the very cells that form into white blood cells called lymphocytes. The bone marrow is where this type of blood cancer takes formidable shape. From the bone marrow these cancerous WBCs flow into the blood. Since the leukemia cells build up stock over the years, most of them having the cancer may not experience any symptoms till a few years have passed. Over time, these leukemia cells can spread to the lymph nodes, liver and spleen. Given the chronic nature of this cancer, it is one of the most difficult cancers to cure.
The healthy normal WBCs that combat infections are overpowered by the leukemia cells, causing several health problems over the years. Since these symptoms are not very stark and visible till a blood test for some other health issue throws up interesting abnormalities in the blood count. In other words, a person suffering from CLL can look healthy and lead a normal life for several years.
A few general symptoms include weakness and extreme bouts of tiredness due to anaemia, weight loss despite not being on any weight loss programme, unexplained fevers, enlarged lymph nodes that present as lumps under the skin in the neck, armpits and groin, and a feeling of fullness inspite of not having eaten, due to the enlarged spleen and liver.
The extreme shortage of red blood cells causes anaemia which in turn leads to tiredness, weakness, and shortness of breath.
The shortage of normal white blood cells called leukopenia can increase the risk of infections. Our body has a reservoir of neutrophils that are our ammunition to combat bacterial infections. When we have low levels of neutrophils, our body is vulnerable to even simple infections such as frequent colds. Patients with CLL may have very high white blood cell counts because of excess numbers of lymphocytes but these leukemia cells do not protect them against infection the way normal white blood cells do.
A shortage of platelets in the blood can cause excessive bruising and bleeding, severe nosebleeds, and bleeding gums.
CLL may also affect our immune system by producing abnormal antibodies that attack our normal blood cells. in other ways. In some people with CLL, the immune system cells make abnormal antibodies that attack normal blood cells. This is called autoimmunity and can cause a low blood count. When this shows up in the blood test, it becomes easy for doctors to diagnose CLL.
CLL can manifest itself and develop slowly over the years. Sometimes, the leukemia may show up symptoms only in the old age and you may not even require treatment.
Certain tests can determine the chronic growth and progress of CLL. These include perusing the patient’s medical history, genetic pattern and physical exam, complete blood count, flow cytometry and other blood tests to check for harmful chemicals in the blood.
Along with tests to check your general health, your doctor may go through your medical history to identify any risk factors in your family or any signs of CLL. During your physical examination, your lymph nodes and other potential areas of infection will be examined. A physical exam provides information about your general health, possible signs of leukemia, and other health problems. During the physical exam, your doctor will pay close attention to your lymph nodes and other areas that might be affected.
The complete blood count (CBC) is a comprehensive test that measures the different cells in the blood, such as the red blood cells, the white blood cells, and the platelets to check any anomalies in the numbers. This test takes into account the differential count which assesses the numbers of the different types of white blood cells. Patients with CLL have been tested and found to have too many lymphocytes than the normal count of 10,000 lymphocytes per cubic millimetre of blood.
This test involves the use of a machine that detects and identifies certain substances or markers in the cells that portend CLL. This is a very tech-savvy instrument used in the diagnosis of CLL. Flow cytometry test can check if the lymphocytes in a sample of blood contain CLL cells.
Other blood tests may be recommended by doctors for patients diagnosed with CLL to measure or detect liver or kidney damage caused by the spread of leukemia cells or to check for any side-effects of chemotherapy medications. Blood immunoglobulin or level of antibodies too may be tested to check if you have the ammunition to stave away infections.
A bone marrow test helps doctors to know how advanced the CLL is. This test includes bone marrow aspiration and biopsy which are usually conducted together. In this test, the samples of the bone marrow are extracted from the back of the hip bone, but may also be derived from other bones under local anaesthesia. This is followed by a bone marrow biopsy where a piece of the bone tissue is sent to the lab for examination to detect the rate of spread of the CLL.
Once the CLL is diagnosed, your team of doctors will discuss the next line of treatment with you depending on the stage of the cancer’s progress.
The various modes of treatment include:
Chemotherapy is prescribed as the first line of treatment for CLL. It involves the use of certain medications to control blood cell counts, treat anaemia and improve the red blood cells as well as the platelets count, and to shrink the enlarged lymph nodes and spleen.
Targeted therapy may be given in combination with chemotherapy. It involves the use of certain medications that may be administered to target molecules on the surface of the leukemia cells. This therapy may be given for intermediate-risk or high-risk CLL and when CLL has recurred or is no longer responding to chemotherapy.
Since the spleen is affected in CLL patients, medications in chemotherapy, or even radiation, can be used to shrink the enlarged spleen. However, when these do not work, the surgical removal of the spleen called splenectomy is resorted to. The removal of the spleen can help improve the blood cell count in some patients.
Radiation therapy may be given to patients with CLL to shrink an enlarged spleen or lymph nodes in one area of the body where chemotherapy does not work, and to relieve pain caused by the growth of leukemia cells in the bone marrow and the joints.
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