This is a very important and interesting question because it differs from staging of other cancers, especially solid tumor cancers. Generally, when we talk about staging, staging reflects how the disease has spread, with stage four meaning that the disease has spread to other organs. This is generally what we think about staging, especially in solid tumors. Now, CLL is unique. It's a blood cancer. Blood goes everywhere. Blood goes to every organ. So, CLL affects every organ. So basically, wherever the blood goes, you can find CLL there. So if we go by the definition of the cancer having spread, we could say stage four, but that's not the case. CLL is staged by a different system. In the United States, we follow the Rye staging system. This is based on the work originally done by Dr. Kanthi Rye in 1975. And it's a very simple classification. We go from stage zero to stage four. Stage zero involves only the presence of increased white blood cell count in the blood. Stage one is presence of lymph nodes. If you feel lymph nodes in the neck, under the arms, or in the groin area, that's stage one. Stage two involves that the physician, when the physician examines the patient, they're able to feel the spleen or the liver. That's called splenomegaly or hepatomegaly. So that's stage two. Stage three is done by blood testing, where the patient is anemic. Hemoglobin is below 10. And stage four is, again, blood test if the platelets are below 100,000. And the beauty about this system is you don't need any sophisticated testing. You don't need any scans. You don't need a bone marrow biopsy. It's blood work, which is just a blood count check and physical examination. And we do the staging, going from stage zero to stage four. And it also reflects the burden of disease. As the burden of disease increases, we see these changes. You get anemic in stage three. You get low platelets in stage four as the amount of disease in the body increases. Staging of CLL requires a physical exam and a visit at the doctor's office and the blood counts. And the different stages of disease vary depending on what the blood counts look like and what the exam findings look like. And so in early stages of the disease, patients may only have an elevated lymphocyte count or a white blood cell count. And then as the stage is advanced, some patients may have increased lymph node sizes that are palpable on examination. The presence of enlargement of the spleen or the livers, which we call splenomegaly or hepatomegaly, can also get into the staging. And then finally, the counts of the hemoglobin or the blood counts and then the platelet counts can also get into staging. And usually when patients have low hemoglobin and low platelet counts, those are kind of the later stages of the disease.
HealthTree • December 11, 2025