Definition Chronic lymphocytic leukaemia (CLL) is a kind of cancer that occurs in a specialised white blood cell called a lymphocyte. The cancerous change occurs in the bone marrow where all blood cells are made. CLL is slow to develop and may affect a person for many years.
What is going on in the body? When the cancerous white cells begin to grow in the bone marrow, normal bloods cells are destroyed or crowded out. These normal blood cells include platelets (used in blood clotting), red blood cells (which carry oxygen), and normal white cells (which fight infections).
The cancerous white cells multiply quickly. They look almost normal but they do not function normally. Some of these cells then leave the bone marrow and travel throughout the body in the bloodstream.
What are the signs and symptoms of the disease? There may be no symptoms. CLL may be found when a routine blood sample is checked. However, the cancerous cells in the bone marrow and in the bloodstream can cause problems such as:
The person is unable to fight infection. The person may become easily infected with viral or fungal infections.
The cancerous cells may build up in lymph nodes throughout the body. This will make the nodes swell.
Low numbers of red blood cells will make the person weak and tire easily. This is called anaemia.
The cancerous cells may spread to the liver and spleen. This causes those organs to swell and not function normally.
What are the causes and risks of the disease? The cause of CLL is unknown.
What can be done to prevent the disease? Nothing can be done to prevent CLL.
How is the disease diagnosed? CLL is diagnosed by examining a blood sample to see if it contains cancerous white cells. Swollen lymph nodes may also be removed for study. Special genetic studies on the blood and lymph nodes will help to confirm CLL. A sample of the bone marrow can be removed and analysed as well, in a procedure known as a bone marrow biopsy.
What are the long-term effects of the disease? Sometimes CLL can become very active very quickly. Most of the time, however, CLL grows very slowly over a number of years. As CLL becomes more active, it will gradually weaken the person and cause serious problems. When the person begins to have symptoms, such as infection or swelling lymph nodes, he or she needs to be treated. Without treatment, active CLL can cause death.
What are the risks to others? There are no risks to others. Cancer does not spread from person to person.
What are the treatments for the disease? The treatment of CLL is usually started only when the person develops symptoms. If the person has no symptoms, the person may simply be monitored. Treatment of CLL includes the following:
steroids to control the growth of CLL cells
chemotherapy, which can sometimes make the CLL completely resolve. This is known as remission.
What are the side effects of the treatments? The side effects depend on the treatment:
Chemotherapy causes side effects that are generally mild and temporary. Hair loss and mild nausea are common.
Steroids can cause puffiness and weight gain over time. Steroids can also interfere with the body's ability to use sugar. This means the person may develop a form of diabetes that will clear up when the person stops taking steroids.
Radiation may cause the skin over the area being treated to turn red.
What happens after treatment for the disease? After treatment, the person will be monitored closely because CLL usually comes back. At that time, treatment will be started again. Different types of treatment can be used if one type is no longer helpful.
How is the disease monitored? Frequent blood samples will be taken to watch for CLL cells in the bloodstream. A physical examination will also be done regularly to see if the lymph nodes are swelling again.
Author: Reviewer: eknowhow Medical Review Panel Editor: Dr John Hearne Last Updated: 23/09/2004 Contributors Potential conflict of interest information for reviewers available on request
