Chronic lymphocytic leukemia (CLL) is sometimes found on blood tests performed for other reasons, so it’s important to tell your doctor about any symptoms you might have.

Detecting and diagnosing CLL at the earliest possible point offers patients the most options for treatment and cure.

If you have possible CLL symptoms, the OSUCCC – James experts will conduct a variety of tests, including:

Physical Exam

During a physical exam, your doctor will check for signs of CLL including unusual lumps or swollen lymph nodes, spleen or liver. If so, you may also have an abdominal CT to evaluate this swelling.

Blood Tests

A blood test measures and counts the different types of cells in the blood (patients with CLL have too many white blood cells).

Other blood tests may be done to measure the amount of certain chemicals and antibodies (proteins) in the blood. A peripheral blood smear is used to analyze how blood cells look under a microscope.

Bone Marrow Aspiration & Biopsy

Testing the bone marrow will tell how advanced the CLL is. During a bone marrow aspiration, your OSUCCC – James specialist will insert a hollow needle into the hip bone or breastbone to remove a small sample of liquid bone marrow.

For a bone marrow biopsy, a hollow needle is inserted into the hip bone to collect a small sample of bone and marrow.

Flow Cytometry

Once blood and bone marrow samples are collected, experts treat the cells from those samples with special antibodies (artificial proteins), then pass them in front of a laser beam. If substances matching the antibodies are on the sample cells, they will stick to the antibodies, and this helps identify and count the cells in the blood or bone marrow.

Cellular and Molecular Tests

Your OSUCCC – James subspecialists may use additional tests to detect specific proteins on cell surfaces and to understand other specific features of the cells they have biopsied. Physical changes in the structure of your DNA (called chromosomal rearrangements) can help the experts determine the most effective, targeted treatment for your specific cancer.

Cytogenetic Analysis

Cytogenetic analysis identifies defects in the DNA structure (chromosomes) in cells that contribute to developing leukemia.

In some CLL cases, certain pieces of DNA may be missing. These missing pieces can be detected under the microscope. Patients with specific missing pieces of genetic material are more likely to need treatment within one to five years after diagnosis than people without these mutations.

Identifying these abnormalities can help the OSUCCC – James subspecialists decide the very best kind of personalized treatment for each CLL patient.


This process identifies cells based on the kind of specific markers (genetic and molecular identifiers) on the surface of the cells. The test can identify the kind of CLL by comparing the cancer cells to the normal cells.

Genomic Testing

Genomic tests analyze genes to determine if specific gene changes (mutations) of cancer cells may exist.

Fluorescent in Situ Hybridization (FISH)

The FISH analysis is a laboratory test for a patient’s chromosomes. It uses fluorescent dyes to identify tiny parts of the chromosomes that are abnormal. The fluorescent dyes are designed to attach only to certain genes.

Staging Chronic Lymphocytic Leukemia

There is no such thing as routine cancer, and chronic lymphocytic leukemia (CLL) behaves differently in each person.

Staging is just one of many ways the OSUCCC – James CLL experts plan the most targeted, accurate way to treat your specific cancer. By identifying CLL stages, your CLL subspecialists can determine how much of the disease is in your body, whether or not it has spread and if so, where it has spread.

Stage 0

In stage 0 CLL, there are too many white blood cells (called lymphocytes) in the blood, but there are no other symptoms of leukemia. Stage 0 CLL is slow-growing.

Stage I

In this stage, there are too many lymphocytes in the blood, and the lymph nodes are larger than normal.

Stage II

In stage II, 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 this stage, there are too many lymphocytes in the blood, and there are not enough red blood cells. The lymph nodes, liver or spleen may also be larger than normal.

Stage IV

In stage IV, there are too many lymphocytes in the blood, and there are not enough platelets. The lymph nodes, liver or spleen may be larger than normal, and there may not be enough red blood cells.

(Source: National Cancer Institute)

If you’ve been diagnosed with chronic lymphocytic leukemia, would like a second opinion or would like to speak with a leukemia specialist, please call The James Line at 800-293-5066 or 614-293-5066 to make an appointment.

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