By Celina M. Nadelman, M.D.
A 78-year-old woman walks into clinic. The first thing I notice is her neck. It is enlarged by several massive lumps on both sides, with the right larger than the left. She said she did not really notice them until possibly a few months ago. She hasn’t been herself lately, as she had been mourning the death of her daughter.
Patient with Massive Neck Lymph nodes
I ask the usual questions during the interview phase of the history and physical exam. At the physical exam, the lumps feel slightly hard to the touch but are non-tender. Ultrasound at the time, showed several masses, all stuck together, extending from her ear, down to her clavicle.
I clean and numb the area with a local anesthetic. I then perform an ultrasound-guided fine needle aspiration biopsy of the neck lesions. In addition to making my usual smears, I put some of the biopsy material in special pink fluid, called RPMI. It is a fluid that helps cells stay alive and healthy. That material goes to another lab for a specialized test called Flow Cytometry.
I take one of the slides and stain it with a quick 3 step stain and look under the microscope.
What I see is a sea of small dark round cells, lymphocytes, that look like soccer balls filling a stadium.
In the next few days, the report from the flow cytometry confirms what I had suspected from my microscopic analysis. The patient has CLL/SLL, chronic lymphocytic leukemia/small lymphocytic lymphoma.
Slide of CLL/SLL
What is CLL/SLL?
CLL/SLL is a cancer of immune cells, called B cell lymphocytes. It can be found mostly in lymph nodes (lymphoma) or in the blood, spleen, and bone marrow (leukemia). It is known as an indolent lymphoma as it is usually slow growing, and many patients do not even have any symptoms. Sometimes it is picked up by a routine blood exam at the yearly physical. Many do not even need to be treated for a while.
Causes and Risk Factors
Causes and risk factors are largely unknown, but this is a lymphoma/leukemia that occurs in older people (average 65 years), with a slight male predominance. A family history of lymphoma may increase your chances of developing this type of malignancy.
Treatment and Prognosis
After a diagnosis of lymphoma, tests are performed to see how advanced and how far the cancer has spread. Leukemia is not staged as blood courses throughout the body.
Depending on the stage directs the type of treatment. As mentioned, one treatment option is “active surveillance”, or watchful waiting. The patient will be monitored to see if any symptoms arise or if the cancer has progressed. As the lymphoma advances different types of treatments may be given, such as chemotherapy, monoclonal antibodies, targeted therapy, radiation, and bone marrow transplant.
The prognosis of CLL/SLL is good, with many patients living without need for treatment. According to the National Cancer institute, 83% of patients survive 5 or more years after diagnosis.
