Chronic Lymphocytic Leukemia (CLL): Stages
What does stage of cancer mean?
The stage of a cancer is whether and how far the cancer has spread in your body. Your healthcare provider uses exams and tests to find out the size of the cancer and where it is. He or she can also see if the cancer has spread into nearby area and to other parts of your body. But CLL is cancer in the blood cells. Tumor size and spread aren't part of staging. Instead, blood and bone marrow tests plus spleen and lymph node size are used to stage this type of cancer.
The stage of a cancer is one of the most important things to know when deciding how to treat the cancer.
What are the stages of CLL?
Healthcare providers use different systems to stage CLL. The system used most often is the Rai system. The Rai system uses stage groupings that can have a value of 0 or of Roman numerals I through IV. The higher the number, the more advanced the cancer is. This system then groups the CLL into low (stage 0), intermediate (stages I and II), and high (stages III and IV) risk groups.
Stage 0. The blood has too many white blood cells called lymphocytes. This is called lymphocytosis. The other blood counts are close to normal, and there are no other symptoms of leukemia. The cancer is slow growing, and this stage is low risk. This means people tend to have longer survival rates and have no or few symptoms.
Stage I. The blood has too many lymphocytes. The lymph nodes are larger than normal. Other organs are normal size, and the red blood cell and platelet counts are close to normal, too. This stage is medium risk.
Stage II. The blood has too many lymphocytes. The spleen is swollen or enlarged. This is called splenomegaly. The liver may be swollen. This is called hepatomegaly. The lymph nodes may also be larger than normal. Red blood cell and platelet counts are close to normal. This stage is medium risk.
Stage III. The blood has too many lymphocytes. The blood also has too few red blood cells. This is called anemia. The lymph nodes, liver, or spleen may be larger than normal. Platelet counts are close to normal. This stage is high risk.
Stage IV. The blood has too many lymphocytes. It also has too few platelets. This is called thrombocytopenia. The lymph nodes, liver, or spleen may be larger than normal. The blood may have too few red blood cells. This stage is high risk.
Other factors that may matter
In addition to the stage of your CLL, other factors may matter when your healthcare provider is looking at your treatment options. These factors include:
The amount of your normal bone marrow that is being replaced by leukemia cells
Blood levels of beta-2 microglobulin and certain other substances
The speed at which your lymphocytes are growing
Chromosome changes found in the cancer cells
If the CLL cells have the ability to make antibodies
Your healthcare provider can tell you more about these factors and how they affect you.
Talking with your healthcare provider
Once your leukemia is staged, your healthcare provider will talk with you about what the stage means for your treatment. Ask questions and talk about your concerns.
June 15, 2018
NCCN Clinical Practice Guidelines in Oncology: CLL/SLL Ver 2.2018. National Comprehensive Cancer Network.
LoCicero, Richard, MD,Stump-Sutliff, Kim, RN, MSN, AOCNS