Cancer Leukemia Diagnosis How Chronic Lymphocytic Leukemia Is Diagnosed By Steph Coelho Steph Coelho Twitter Steph Coelho is a freelance health writer, web producer, and editor based in Montreal. She specializes in covering general wellness and chronic illness. Learn about our editorial process Published on December 17, 2021 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Douglas A. Nelson, MD Medically reviewed by Douglas A. Nelson, MD LinkedIn Douglas A. Nelson, MD, is double board-certified in medical oncology and hematology. He was a physician in the US Air Force and now practices at MD Anderson Cancer Center, where he is an associate professor. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Self-Checks Physical Examination Labs and Tests Imaging Differential Diagnosis Doctors will perform a battery of tests to diagnose chronic lymphocytic leukemia (CLL). This usually slow-growing blood cancer affects specific white blood cells called lymphocytes, which are produced in the bone marrow and are involved in immune functions. In many people, early-stage CLL doesn’t produce any noticeable symptoms. Healthcare providers may only realize something is wrong after getting back abnormal routine blood test results. Healthcare providers who suspect CLL will perform further testing. This article discusses the steps involved in diagnosing CLL. simon's photo / Getty Images Self-Checks/At-Home Testing There’s no reliable way to test for CLL at home. Many people who have this type of blood cancer may not even know they have it. You may have no symptoms early on or experience vague, nonspecific symptoms that can be hard to attribute to one cause. Physical Examination Doctors will usually ask you about your medical history, including: What symptoms you’re experiencingHow long you’ve had bothersome symptomsWhether you have any risk factors for CLLWhether you have any other health issues Chronic Lymphocytic Leukemia Symptoms Symptoms of this type of blood cancer may include:Tiredness or feeling run-downRecurring infectionsSwollen lymph nodesA feeling of pressure or fullness in the abdomenEasy bleeding or bruisingFever ChillsWeight lossNight sweatsHowever, many people don’t have symptoms at the time of their initial diagnosis. During the physical exam, your healthcare provider will also check for swollen lymph nodes. They may also ask the following questions to determine whether you have any risk factors for CLL: Do you have a family history of CLL or other blood cancers? Have you had prior exposure to herbicides such as Agent Orange, or were you in Vietnam during the Vietnam War? (This chemical was used to kill vegetation at that time.) Have you been exposed to radon? (This is a colorless, odorless gas that may be present in homes and other buildings.) Labs and Tests A healthcare provider who suspects you have chronic lymphocytic leukemia will check your blood by drawing it from a vein in your arm. Healthcare providers may suspect CLL only after seeing the results of routine blood tests, particularly a complete blood count (CBC). In this case, they may request further testing (such as a blood smear, a sample of blood tested on a specially treated slide) to check for or verify the presence of: A high white blood cell count, specifically lymphocytes A low red blood cell count (cells that carry oxygen to the tissues) A low platelet count (cells involved in clotting) Abnormal appearance of lymphocytes, also known as smudge cells Beta-2-microglobulin, which may mean you have a more advanced case of CLL Flow cytometry is a test that can help identify cells by their characteristics. In the case of CLL, flow cytometry can identify whether lymphocytes contain cancerous cells. This test can help differentiate CLL from diseases with similar symptoms. Bone marrow aspiration or biopsy can help healthcare providers determine how far advanced the cancer is and check whether you’re responding to treatment. In this procedure, a needle is inserted into a bone (often the hip) to remove some of the bone marrow to be analyzed in a lab. Rarely, a spinal tap, in which a needle is used to obtain a sample of cerebrospinal fluid from your spinal canal, or a lymph node biopsy (removing a sample lymph node for testing) are used to determine the spread of CLL. Additionally, healthcare providers may recommend genetic testing to check for chromosomal abnormalities (changes in the structures in the nuclei of cells that carry genes). This can help them determine which treatment might work best for your condition. What Stages of CLL Should Be Treated? Imaging Healthcare providers don’t typically use imaging tests to diagnose CLL. Still, they can use them to check whether the cancer has spread and to find out whether treatment is working: A computed tomography (CT) scan can tell your healthcare provider whether your lymph nodes are enlarged. This type of imaging test can also show whether the cancer has spread to your organs. Magnetic resonance imaging (MRI) can tell your healthcare provider if there is any brain or spinal cord involvement, but it’s rarely used to diagnose CLL. Ultrasound technology can help your healthcare provider identify enlarged lymph nodes or organs like the liver or spleen, which may be a sign of CLL, as well as a factor in prognosis (outcome). Differential Diagnosis Because many blood cancers present similarly and share symptoms, your healthcare provider may enlist the help of a hematopathologist, a doctor specializing in laboratory medicine, blood disorders, and blood cancer. Other conditions with similar symptoms include: Anemia: Disorders characterized by a low red blood cell count or poor oxygen-carrying ability of hemoglobin in red blood cells Other types of leukemia: Cancers affecting the blood-producing cells of the bone marrow Lymphoma: A cancer of the lymphocytes in the lymphatic system Human immunodeficiency virus (HIV): Viral infection that damages the immune system Hepatitis B or C: Viral infections of the liver Myelodysplastic syndromes (MDS): Disorders of the blood-producing cells of the bone marrow Summary To diagnose chronic lymphocytic leukemia, healthcare providers will start by taking a medical history and performing a physical examination. If they suspect CLL, they will order a complete blood count and other blood tests. They may also use genetic testing to confirm a diagnosis and help guide treatment options. A bone marrow biopsy and imaging can help doctors determine whether the cancer has spread. A Word From Verywell Waiting for a diagnosis of chronic lymphocytic leukemia can feel daunting. But keep in mind that CLL is typically a slow-growing cancer and medical professionals have many tools at their disposal to help manage and control the disease. Once you have a confirmed diagnosis, your healthcare provider can help you determine the right treatment plan for your needs. Was this page helpful? Thanks for your feedback! Limiting processed foods and red meats can help ward off cancer risk. These recipes focus on antioxidant-rich foods to better protect you and your loved ones. Sign up and get your guide! Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 6 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. American Cancer Society. Signs and symptoms of chronic lymphocytic leukemia. American Cancer Society. How is chronic lymphocytic leukemia diagnosed? American Cancer Society. What are the risk factors for chronic lymphocytic leukemia. Leukemia & Lymphoma Society. Related diseases. National Cancer Institute. Chronic lymphocytic leukemia treatment (PDQ)-Patient version. Updated September 20, 2021. National Organization for Rare Disorders. Chronic lymphocytic leukemia.