Chronic lymphocytic leukemia (CLL) is a type of blood cancer that starts in the bone marrow and invades the blood. CLL is one of the most common types of leukemia in adults. It’s also known as B-cell chronic lymphocytic leukemia.
CLL can often go undetected for a long time as symptoms may not appear in the early stages. However, as it progresses, there are a number of telltale signs and symptoms that point to CLL. The diagnosis is confirmed through a blood test and bone marrow biopsy.
What are the symptoms of CLL?
Some of the most common symptoms of CLL include:
- Fatigue
- Bruising easily
- Swollen lymph nodes
- Repeated infections
- Night sweats
- Bone pain
- Weight loss
- Enlarged liver or spleen
However, since these symptoms are vague and common to many other conditions, CLL can often be mistaken for something else. Some health issues that can show similar signs and symptoms include anemia, infection, other blood cancers, autoimmune disorders, and age-related issues.
How is CLL diagnosed?
There are a few key tests that doctors use to diagnose CLL:
- Blood tests: A complete blood count (CBC) is done to check for high white blood cell count and low red blood cell, platelet counts. A peripheral blood smear can identify abnormal looking lymphocytes.
- Bone marrow biopsy: A sample of bone marrow is extracted and examined to check for cancerous lymphocytes.
- Immunophenotyping: Special tests identify proteins on the surface of abnormal lymphocytes to confirm CLL.
- Genetic testing: Chromosomal analysis helps detect genetic mutations associated with CLL.
Based on the results of these investigations, doctors can conclusively diagnose CLL.
What conditions may be confused for CLL?
Some health problems that have overlapping signs and symptoms with CLL include:
Anemia
Anemia occurs when you have a decreased number of red blood cells or hemoglobin. It can cause fatigue, weakness, pale skin, chest pain, dizziness, and headache. Anemia can result from iron deficiency, certain medications, leukemia, kidney disease, pregnancy, and other conditions. Doctors diagnose anemia with CBC, iron studies, and other relevant tests.
Hairy cell leukemia
Hairy cell leukemia is another type of blood cancer that affects B cells. Symptoms include fatigue, weakness, abdominal pain, infections, and enlargement of the liver and spleen. It’s diagnosed with blood tests and a bone marrow biopsy.
Hodgkin lymphoma
Hodgkin lymphoma starts in the lymphatic system, most often involving lymph nodes in the neck or chest. Symptoms include swollen lymph nodes, fatigue, fever, night sweats, and weight loss. Diagnosis involves lymph node biopsy, imaging tests, and blood work.
HIV/AIDS
People living with HIV are at higher risk of certain cancers, including Hodgkin lymphoma and different types of leukemia. HIV infection progresses to AIDS as CD4 counts drop below 200 cells/mm3. Symptoms include swollen glands, fever, fatigue, rashes, cough, and night sweats.
Autoimmune disorders
Autoimmune diseases like rheumatoid arthritis and lupus can have similar symptoms as CLL. These include fatigue, joint pain, rashes, fever, and enlarged lymph nodes or spleen. Specific antibodies in the blood help distinguish between autoimmune disorders and blood cancers.
Who is at risk of CLL misdiagnosis?
Certain factors that raise the likelihood of a missed or delayed CLL diagnosis include:
- Older age: Risk increases over 50 years old
- Male gender: CLL is more common in men
- Caucasian ethnicity: More predisposed compared to other groups
- Family history: Having a first-degree relative with CLL
- Exposure to chemicals: Pesticides, diesel fuel, Agent Orange
- Early stage: No or subtle symptoms initially
- Nonspecific symptoms: Fatigue, infections, enlarged nodes have many causes
- No obvious lymph node swelling
- Concurrent health issues: More common after age 50 years
These factors can interfere with considering a diagnosis of CLL. However, once suspected, doctors can easily verify it with a blood test.
What are the complications of misdiagnosed CLL?
Misdiagnosing or delaying the diagnosis of CLL can lead to the following complications:
- Disease progression: CLL gets worse without treatment
- Organ damage: From enlarged spleen/liver, leukemia cells
- Severe anemia: Low red blood cell count causes fatigue
- Immune deficiency: Prone to recurrent infections
- Bleeding: Low platelets increase bruising and bleeding risk
- Transformation: Can transform to aggressive lymphoma
That’s why prompt diagnosis and treatment of CLL is crucial. Early intervention improves response to CLL treatment and overall prognosis.
How to prevent misdiagnosis of CLL
Here are some ways to avoid delayed or incorrect diagnosis of CLL:
- See a doctor for persistent symptoms like fatigue, fever, or swellings.
- Undergo recommended screening blood work after age 50 years.
- Get annual physical exams.
- Discuss risk factors like family history with your doctor.
- Make sure to educate doctors on travel, chemical exposures.
- Ask doctors to explain their diagnosis and treatment plan.
- Seek a second opinion if doubts arise.
- Follow up on all test results ordered by your doctor.
Acting quickly on suspicious symptoms and communicating openly with your healthcare team can help diagnose CLL accurately.
Conclusion
CLL can often be mistaken for other common conditions like anemia, infections, autoimmune diseases, or simply dismissed as age-related issues. However, simple blood tests can readily confirm the diagnosis of CLL. Being aware of the disease, its symptoms, and risk factors allows for prompt diagnosis and treatment. This helps improve prognosis and survival in CLL.