Staging

Staging is a way of describing a cancer, such as where it is located, if or where it has spread, and if it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis. There are different stage descriptions for different types of cancer.

There is a relationship between the stage of the CLL and the prognosis, with patients in the earlier stages having better long-term survival. Importantly, however, there is a wide range of outcomes even in patients within a given stage, and the stage alone does not precisely predict the prognosis for an individual patient.

Rai staging system (stage 0, I, II, III, or IV)

In this staging system, CLL is divided into different stages ranging from 0 (zero) to IV (four). This staging system classifies the leukemia according to whether a patient has, or does not have, any of the following:

• Lymphocytosis (high levels of lymphocytes)
  
  
• Hepatomegaly (an enlarged liver)
  
  
• Lymphadenopathy (swollen lymph nodes)
  
  
• Splenomegaly (an enlarged spleen)
  
  
• Anemia (low levels of red blood cells)
  
  
• Thrombocytopenia (low levels of platelets)

This chart summarizes the Rai stages.

Chart adapted from the American Society of Hematology, Kay et. al. 2002, vol. 1:193, Table 8 (http://www.asheducationbook.org/cgi/content-nw/full/2002/1/193/T8)

Stage 0: The patient has lymphocytosis (more than 15,000 per cubic millimeter of blood), but no other physical signs or symptoms.

Stage I: The patient has lymphocytosis and swollen lymph nodes. The patient does not have an enlarged liver or spleen, anemia, or low levels of platelets.

Stage II: The patient has lymphocytosis and an enlarged liver or spleen and may or may not have swollen lymph nodes.

Stage III: The patient has lymphocytosis and anemia. The patient may or may not have swollen lymph nodes and an enlarged liver or spleen.

Stage IV: The patient has lymphocytosis and low levels of platelets. The patient may or may not have swollen lymph nodes, an enlarged liver or spleen, or anemia.

If the CLL grows and worsens, the stage may change in an individual patient over time, and these changes vary widely from patient to patient.

Risk group

Sometimes the phrase “risk group” is used as a means of expressing the likelihood that the disease may worsen and require treatment.

Low risk: Rai stage 0

Intermediate risk: Rai stages I and II

High risk: Rai stages III and IV

Binet classification (stage A, B, or C)

European doctors use a different staging system, based on whether the CLL is present in the lymph nodes (in the neck, under the arms, or in the groin area) and whether the patient has low levels of red blood cells or platelets. The stages are called A, B, and C.

Chart adapted from the American Society of Hematology, Kay et. al.2002, vol. 1:193, Table 8 (http://www.asheducationbook.org/cgi/content-nw/full/2002/1/193/T8)

Stage A: The patient does not have anemia or low levels of platelets. The cancer can be palpated (felt) in fewer than three areas of lymph nodes (Rai stages 0, I, and II).

Stage B: The patient does not have anemia or low levels of platelets. The cancer is present in three or more areas of lymph nodes (Rai stages I and II).

Stage C: The patient has anemia and/or low levels of platelets. The cancer is present in any number of lymph nodes (Rai stages III and IV).

Recurrent CLL

Recurrent CLL is CLL that comes back after treatment.