Cancer, Chronic Lymphocytic Leukemia

Chronic lymphocytic leukemia (CLL) is a type of cancer that starts in the blood and bone marrow. Bone marrow is the soft, spongy material inside your bones where blood cells are made.

CLL is called "chronic" because it usually develops more slowly than other types of leukemia. "Lymphocytic" refers to the specific type of white blood cells, called lymphocytes, that are affected. Lymphocytes are part of your body's immune system and help fight off infections.

This type of cancer most often affects people who are older. While there's no cure for CLL, there are treatments available to help manage the disease and improve quality of life.

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Chronic lymphocytic leukemia (CLL) often has no noticeable symptoms initially. As the disease progresses, certain signs and symptoms can appear. These might include:

• Swollen lymph nodes: These might be noticeable, but usually don't cause pain. Lymph nodes are small, bean-shaped organs located throughout the body, part of the immune system. If CLL affects them, they can swell up.

• Feeling tired all the time (fatigue): This is a common symptom of many illnesses, and CLL is no exception.

• Fever: A fever is a rise in body temperature. It can be a sign of infection or other health issues, including CLL.

• Abdominal pain: Pain in the upper left part of your belly might happen if the spleen, an organ that helps fight infection, becomes enlarged due to CLL.

• Night sweats: Sweating heavily at night is a symptom that can occur in various conditions, including CLL.

• Losing weight without trying: Unexplained weight loss can be a sign of many different health problems, including CLL.

• More frequent infections: The immune system weakens with CLL, making people more susceptible to infections. This means getting sick more often than usual.

It's important to remember that these are just some possible symptoms. If you're concerned about any of these or other unusual symptoms, it's crucial to see a doctor for proper diagnosis and treatment.

If you're experiencing any ongoing health problems that are concerning you, schedule a visit with your doctor.

Chronic lymphocytic leukemia (CLL) is a type of cancer that starts in the blood-forming cells. Scientists don't fully understand what triggers the disease. However, they know that something causes changes in the DNA of these blood cells. DNA is like a set of instructions for the cells, telling them how to function. These changes, or mutations, tell the blood cells to make abnormal lymphocytes.

Lymphocytes are a type of white blood cell. Normal lymphocytes have a lifespan; they live and divide for a while, and then die. But in CLL, the abnormal lymphocytes don't die. Instead, they keep multiplying, even though they don't function properly. These faulty lymphocytes build up in the blood and certain organs, causing problems. For example, they can crowd out healthy cells in the bone marrow, the place where blood cells are made. This overcrowding can interfere with the body's ability to produce enough healthy blood cells.

Researchers are still studying the exact steps that lead to this disease. They're working to uncover the reasons why these abnormal cells develop and grow out of control.

Several things might make you more likely to get chronic lymphocytic leukemia (CLL).

• Age: CLL is most common in older adults. As people get older, their cells may have more problems with growth and repair, increasing the possibility of this type of cancer.

• Race: White people seem to have a higher chance of getting CLL than people of other races. Scientists are still studying why this difference exists.

• Family history: If someone in your family has had CLL or other blood cancers like leukemia or lymphoma, you might have a higher risk. This could mean that some genes or other factors are passed down that make you more vulnerable.

• Exposure to certain chemicals: Exposure to some chemicals, such as herbicides and insecticides, potentially increases the risk of CLL. For example, Agent Orange, a herbicide used in the Vietnam War, has been linked to a higher chance of developing CLL. The exact ways these chemicals might cause harm are still being researched.

• A condition called monoclonal B-cell lymphocytosis (MBL): MBL means there are too many of a specific type of white blood cell (B cells) in your blood. In a small percentage of people with MBL, this condition can turn into CLL. Having MBL and a family history of CLL could make your risk even higher. It's important to note that most people with MBL never develop CLL.

It's important to remember that these factors increase your risk of developing CLL. Many people with these factors never get the disease. If you have concerns about your risk, talking to a doctor is crucial. They can help you understand your individual situation and discuss steps you can take.

Chronic lymphocytic leukemia (CLL) can lead to several health problems.

Frequent Infections: People with CLL often get infections more often than usual. This is because their blood may not have enough of the proteins (called antibodies or immunoglobulins) that fight off germs. To help, a doctor might suggest regular infusions of immunoglobulins. These infusions provide extra antibodies to help the body fight infections.

More Aggressive Cancer: In some cases, CLL can change into a faster-growing type of cancer called diffuse large B-cell lymphoma. This change is sometimes called Richter's syndrome. It's important to note that this doesn't happen to everyone with CLL.

Increased Risk of Other Cancers: People with CLL are more likely to develop other types of cancer, such as skin cancer, lung cancer, or cancers of the digestive system. This increased risk is something doctors monitor closely.

Immune System Problems: Occasionally, CLL can cause the body's immune system to malfunction. This can lead to conditions where the immune system mistakenly attacks healthy red blood cells (causing autoimmune hemolytic anemia) or platelets (causing autoimmune thrombocytopenia). These conditions can cause symptoms like fatigue and bleeding problems.

Diagnosing chronic lymphocytic leukemia (CLL) involves several tests to identify the presence and characteristics of the disease. These tests typically look at your blood and sometimes your bone marrow.

Blood Tests: Doctors use blood tests to understand the cells in your blood. One important test is a complete blood count (CBC). This counts the different types of blood cells, including lymphocytes. Lymphocytes are a type of white blood cell. A high number of a specific type of lymphocyte called B-cells might be a sign of CLL. Additional blood tests analyze the lymphocytes themselves.

Looking for Genetic Changes: A test called fluorescence in situ hybridization (FISH) examines the chromosomes within the abnormal lymphocytes. This helps doctors understand if there are any changes in the genetic material of the cells. This information can help predict how the cancer might behave and help choose the best treatment approach.

Identifying the Problem: A test called flow cytometry or immunophenotyping helps doctors figure out why there are more lymphocytes than usual in the blood. Is it CLL, another blood disorder, or perhaps your body's response to an infection? Flow cytometry can also tell doctors about the characteristics of the CLL cells, which helps predict how quickly the disease might progress.

Other Tests: In some cases, further tests are needed. These might include tests looking for specific traits of the CLL cells that impact the outlook (prognosis). A bone marrow biopsy and aspiration is a procedure where a small sample of bone marrow is taken and examined under a microscope. Imaging tests, such as CT scans (computerized tomography) or PET scans (positron emission tomography), might also be used to look for the disease in other parts of the body.

Staging the Cancer: Once the diagnosis is confirmed, doctors determine the stage of the CLL. Stages help doctors understand how aggressive the cancer is and how likely it is to worsen quickly. Staging often uses letters or numbers. Early-stage CLL may not need treatment right away. People with later-stage CLL may need treatment sooner. The stage of the disease helps guide treatment decisions.

Chronic lymphocytic leukemia (CLL) treatment depends on several things, like how advanced the cancer is, if you have any symptoms, your overall health, and what you prefer.

If your CLL isn't causing problems and isn't getting worse, you might not need treatment right away. Doctors often monitor these cases because early treatment doesn't usually help people live longer with early-stage CLL. Instead of treating you before you need it, doctors watch carefully and reserve treatment for when the leukemia progresses.

Your doctor will set up a regular check-up schedule. This might involve seeing your doctor and having blood tests every few months to track how the CLL is progressing.

If treatment is needed, options include:

• Chemotherapy: This uses drugs to kill fast-growing cells, including cancer cells. These drugs can be given through a vein or taken as pills. Your doctor might use one drug or a combination of them.
• Targeted Therapy: This type of treatment targets specific problems within the cancer cells. By finding and blocking these problems, targeted therapies can help kill the cancer cells.
• Immunotherapy: This treatment uses your body's immune system to fight the cancer. Sometimes cancer cells hide from your immune system. Immunotherapy helps your immune system recognize and attack these hidden cancer cells.
• Bone Marrow Transplant (Stem Cell Transplant): This involves using strong chemotherapy drugs to kill the stem cells in your bone marrow that are creating the diseased white blood cells (lymphocytes). Then, healthy stem cells from a donor are given to you. These healthy stem cells travel to your bone marrow and start making healthy blood cells. Bone marrow transplants are less common for CLL now, as newer drug combinations have proven more effective. However, it may still be an option in some cases.

These treatments can be used alone or together. Your doctor will closely monitor you for any side effects. They might also recommend supportive care to help prevent or relieve symptoms.

Supportive care can include:

• Cancer Screening: Your doctor will check your risk of developing other cancers and may suggest screenings for other cancers.
• Vaccinations: Your doctor may recommend vaccines to help prevent infections like pneumonia and the flu.
• Regular Check-ups: Regular check-ups are important to monitor your health during and after treatment.

No alternative treatments have been scientifically proven to cure CLL.

While some alternative therapies may help with the fatigue that is common in CLL, your doctor can treat the underlying cause of the fatigue. In some cases, medication alone may not be enough. Alternative therapies such as acupuncture, exercise, massage, and yoga may help reduce fatigue. Talk to your doctor about any alternative therapies you're considering, and together you can develop a plan to manage fatigue.

CLL is often a slow-growing cancer. While some might call this a "good" type of cancer, a diagnosis of any kind of cancer can be difficult to handle.

It's natural to feel shocked and anxious after a CLL diagnosis. You will likely develop your own ways of coping. In the meantime:

• Learn about your CLL: Ask your doctor questions and research the condition through reliable sources. Your local library, the National Cancer Institute, the American Cancer Society, and the Leukemia & Lymphoma Society are good places to start.
• Seek Support: Lean on family and friends. Sharing your diagnosis can be difficult, but talking to those closest to you will help. Be open to receiving help from others.
• Connect with Others: Join a support group, either online or in person. Sharing experiences and advice with other CLL patients can be very helpful.
• Cope with the Ongoing Nature of the Disease: CLL often requires ongoing monitoring and worries about blood counts. Find healthy ways to relax, such as exercise, yoga, or gardening. If needed, consider talking to a counselor, therapist, or social worker to address the emotional challenges of a chronic illness.