The leukaemia whose first treatment is to do nothing

Leukaemia is cancer of the blood cells, beginning in blood-forming tissue such
as bone marrow. Marrow makes the cells that become white blood cells (which
fight infection), red blood cells (which carry oxygen) and platelets (which
clot). In leukaemia the marrow produces large numbers of abnormal cells —
usually white cells — which build up and crowd out the healthy ones.

Chronic lymphocytic leukaemia is the chronic kind, and "chronic" here
means precisely one thing: it usually gets worse slowly. The marrow makes
abnormal lymphocytes, a type of white cell; as they crowd out the healthy
cells the results are infection, anaemia and easy bleeding, and the abnormal
cells can spread beyond the blood. CLL is one of the most common leukaemias
in adults, usually arriving during or after middle age, and is rare in
children.

Why the first treatment is no treatment

Treatment for CLL includes watchful waiting — no treatment now, with your
provider checking regularly for signs or symptoms appearing or changing —
alongside targeted therapy, chemotherapy, radiation therapy, immunotherapy,
and chemotherapy with a bone marrow or stem cell transplant.

Watchful waiting is not resignation. The goals of CLL treatment are to slow
the growth of the leukaemia cells and to give long periods of remission,
where signs and symptoms are reduced or gone. CLL may return after a
remission and need treating again. Against a disease that advances slowly and
a treatment that is itself demanding, starting later can be the better trade —
which is a genuinely different logic from most cancer care, and worth
understanding before it is offered.

What it looks like

Nothing, at first. CLL causes no symptoms in the beginning. Later:

• Swollen lymph nodes — painless lumps in the neck, underarm, stomach or groin
• Weakness or tiredness
• Pain or a feeling of fullness below the ribs
• Fever and infection
• Easy bruising or bleeding
• Petechiae — tiny red dots under the skin, caused by bleeding
• Weight loss for no known reason
• Drenching night sweats

Cause and risk

CLL happens when the DNA in bone marrow cells changes. What causes those
changes is unknown, which is why nobody can predict who will get it. A few
factors raise the risk:

How it is found

A physical exam and medical history, then blood tests: a complete blood count
with differential, and blood chemistry tests measuring electrolytes, fats,
proteins, glucose and enzymes — a basic or comprehensive metabolic panel,
kidney and liver function tests, an electrolyte panel. Flow cytometry
checks for leukaemia cells and identifies which type, on blood, marrow or
other tissue, and genetic tests look for gene and chromosome changes. After a
diagnosis, imaging and bone marrow tests show whether it has spread.

Source: National Cancer Institute, via MedlinePlus.