Blood tests, bone marrow tests, imaging tests, and biopsy are some of the tests used to help diagnose chronic lymphocytic leukemia (CLL).

Chronic lymphocytic leukemia (CLL) is a slow-growing leukemia that affects white blood cells (WBCs), which are called lymphocytes. CLL affects B lymphocytes, or B cells, which help your body fight infections.

Most people who receive a diagnosis of CLL experience few or no symptoms. A doctor may only suspect CLL when the results of a routine blood test come back abnormal.

In this case, they may recommend a wide range of tests to diagnose CLL, including blood tests, bone marrow tests, and imaging tests, among others.

Keep reading to learn more about how CLL is diagnosed and staged.

At the start of your visit, a healthcare professional will perform a physical and medical history examination.

According to the American Cancer Society (ACS)Trusted Source, a doctor may ask you questions about:

During your exam, the doctor will then look, listen, and feel for signs that point to CLL, the most common being swollen lymph nodes in your neck, armpit, or groin. CLL cells can also be found in your spleen and liver.

Other symptoms of CLL may includeTrusted Source:

Blood tests are often the first tests to be performed and are usually enough to diagnose CLL, according to the ACSTrusted Source. These tests may include the following types:

Complete blood count with differential

A complete blood count with differential measures the various blood cell types in your body, such as red blood cells (RBCs), WBCs, and platelets. It also detects the amount of each type of WBC you have.

A lymphocyte count of more than 5,000 lymphocytesTrusted Source per cubic millimeter (mm³), known as lymphocytosis, may be a strong indication of CLL. Your RBC and platelet counts may also be lower than usual.

This test alone, however, is not enough to confirm a diagnosis of CLL.

Flow cytometry

Flow cytometry is a lab test that uses a special machine to confirmTrusted Source a CLL diagnosis. It finds, identifies, and counts CLL cells by searching for key markers within cells or on their surface.

Bone marrow is found inside certain bones and is where new blood cells are created. A bone marrow test may be used to evaluate whether you have cytopenia and help determine how far your cancer has progressed.

There are two common typesTrusted Source of bone marrow tests:

  • Bone marrow aspiration: During this test, a needle is inserted into the back of your hip bone to collect bone marrow samples.
  • Bone marrow biopsy: During this test, a longer needle is used to collect a bone sample. It’s usually performed shortly after aspiration.

If you have CLL, the results of your bone marrow test may show:

  • marrow with too many cells that form blood
  • the number of normal cells within your bone marrow that have been replaced by CLL cells
  • the CLL spread pattern in your marrow, which can either be:
    • nodular or interstitial (small clusters of cells), which may suggest a better outlook
    • diffuse or scattered, which may indicate a more advanced stage of CLL

Sometimes, healthcare professionals use lymph node biopsies to help examine whether swollen lymph nodes contain any lymphocytes. According to the ACSTrusted Source, this could also help see if CLL has advanced.

Several types of imaging tests may be used to see what may be causing your symptoms, such as swollen lymph nodes, liver, or spleen.

Some imaging tests may includeTrusted Source:

Genetic tests for CLL look at changes in certain chromosomes or genes. In some cases, parts of chromosomes may be missing, known as deleted.

For instance, deletion in parts of chromosomes 11 and 17Trusted Source may indicate a less favorable outlook and shorter life expectancy, while deletion in parts of chromosome 13 is linked to better outcomes and longer survival times.

The most common genetic test for CLL is a fluorescent in situ hybridization (FISH) test, according to Cancer Research UK. Other tests include polymerase chain reaction (PCR) and complementary or copy-DNA (cDNA) sequencing.

Diagnostic tests can help healthcare professionals rule out other conditions that may be causing similar symptoms to CLL. These conditions may includeTrusted Source:

CLL can also morph into more aggressive cancers, such as diffuse large B cell lymphoma or Hodgkin’s disease.

The main diagnostic criteria for CLL is having a lymphocyte count of more than 5,000 mm³ for more than 3 months. This can be detected by blood tests.

Blood tests and lymph node biopsies are usually enough to confirm a diagnosis of CLL, according to the ACS. However, sometimes a doctor may order imaging and genetic tests for further examination.

CLL has a higher survival rate than many other cancers. The 5-year survival rate is around 88%, which means more than 8 out of 10 people with the condition are alive 5 years after receiving a diagnosis.

CLL is a blood cancer that affects your white blood cells. After a physical exam, a doctor may use a variety of tests to help diagnose CLL.

Blood tests are often used for diagnosis. Other tests may include bone marrow and lymph node biopsies, genetic tests, and imaging tests.