Chronic lymphocytic leukemia (CLL) is a type of blood cancer. It affects lymphocytes, a type of immature white blood cell that the body produces in the bone marrow.
People with CLL may experience discomfort, swelling, and pain in the abdomen if their spleen enlarges. In rare cases, CLL can also affect mucosal tissues, such as those lining the gastrointestinal (GI) tract.
This article discusses the link between CLL and stomach pain in more detail. It also looks at ways to prevent and treat CLL, the other possible symptoms, and the outlook for people with this condition.
People with CLL may experience various symptoms involving the abdomen or stomach, such as:
- discomfort, pain, or tenderness
- feeling full after eating small amounts of food
- diarrhea or vomiting
- abdominal cramping
- loss of appetite
- unexplained weight loss
In most cases, people with CLL do not experience abdominal symptoms due to the disease until it progresses and becomes more severe.
Research suggests that CLL infiltrates and affects the GI tract in about 5.7–13% of cases. When CLL affects the GI tract, doctors may call it Richter’s syndrome.
People with CLL may experience abdominal swelling, discomfort, and tenderness as a result of their spleen becoming larger. Less commonly, they may also feel full after eating small amounts of food, as the spleen can press on the stomach, making it smaller and able to hold less.
In rare cases, CLL infiltrates the lining of the GI tract, causing inflammation and ulcers or open wounds. People may experience symptoms similar to those of inflammatory bowel disease (IBD) and malabsorption disorders. These symptoms may include diarrhea, nausea, vomiting, abdominal pain and cramping, and unintentional weight loss.
CLL is cancer that develops in lymphocytes, which are white blood cells that form in the bone marrow and help fight infection.
Lymphocytes make up most of the lymph tissues in the lymph nodes, thymus gland, adenoids, tonsils, and spleen. They are also present in the GI tract, bone marrow, and respiratory system.
CLL is a type of leukemia that develops gradually over time.
About 50–75% of people with CLL do not experience noticeable symptoms. Due to this, doctors diagnose most people with CLL during routine blood work.
The symptoms of CLL often begin when the cancerous cells crowd out healthy cells in the bone marrow or migrate to other organs or tissues. When symptoms first appear, they are typically mild, but they then become increasingly severe. CLL can cause many nonspecific symptoms, so a person may feel as though they have a cold or the flu.
Possible symptoms of CLL that do not relate to the abdominal area include:
- swollen lymph nodes
- frequent infections that are difficult to recover from
- unexplained exhaustion or weakness
- unexplained breathlessness or breathing issues
- excessive or abnormal bruising
- nosebleeds and heavy periods
- bone pain
- night sweats
- low grade fever
- jaundice, which is a yellowing of the mucous membranes, whites of the eyes, or skin
Doctors do not yet have a way to prevent leukemia. However, some types of leukemia, including CLL, may have links to toxins,
Many people do not experience symptoms of CLL for years and do not require treatment. However, as the disease progresses, these individuals may need treatment to extend their lives.
When and how a doctor treats someone’s CLL depends on a few factors,
- the type of CLL
- whether CLL is causing problems or symptoms
- the person’s age
- their overall health and any underlying conditions
- the likelihood of treatment success
- how the patient feels about the treatment options and their potential side effects
Chemotherapy is typically the first-line therapy for CLL.
Doctors may use chemotherapy in conjunction with other treatment options, such as monoclonal antibody therapy. This therapy binds antibodies to cancer cells and destroys them. Treatment can also include medications to treat or prevent infections or improve low blood cell levels.
For instance, some people may take a combination of the monoclonal antibody rituximab and the chemotherapy drugs fludarabine and cyclophosphamide. Alongside the oral chemotherapy medication chlorambucil, doctors use obinutuzumab or ofatumumab, which have the same drug target as rituximab.
Small molecule inhibitors, such as bendamustine hydrochloride, idelalisib, and ibrutinib, can also sometimes form part of a CLL treatment regimen.
In 2017, the Food and Drug Administration (FDA) approved the combination medication Rituxan Hyecela (rituximab and hyaluronidase human) for CLL treatment.
In recurring or aggressive cases of CLL, an individual may have a blood or bone marrow stem cell transplant. This procedure replaces diseased cells with healthy blood cells that are able to mature into bone marrow cells.
Doctors may treat CLL until the symptoms lessen and then stop treatment until the symptoms worsen again.
Many people with CLL live for many years with a high quality of life.
There is no cure for CLL, so treatment aims to extend and improve someone’s life by reducing their symptoms. Doctors treat many people intermittently as their symptoms reoccur.
A person’s outlook depends on their age, overall health, underlying conditions, and stage of CLL. Typically, people who are over the age of 65 years or have a more advanced stage of CLL have a less positive outlook.
Genetic changes in CLL cells and increased beta-2 microglobulin protein levels in the blood can make CLL more challenging to treat, potentially affecting a person’s outlook.
Doctors classify people with CLL into different risk groups depending on certain factors. Based on these risk groups, the estimated percentages of people surviving 5 years or more after their diagnosis is:
- 95% for low risk
- 80% for intermediate risk
- 65% for high risk
- 25% for very high risk
People with more advanced or severe CLL may experience abdominal swelling, discomfort, tenderness, and pain. They may also feel full after eating small amounts. More rarely, someone with CLL may develop GI tract inflammation or ulcers, which can cause symptoms such as diarrhea, nausea, vomiting, cramping, and unexplained weight loss.
Anyone who thinks that they may have CLL should speak with a doctor. People with a confirmed diagnosis who experience symptoms of more advanced or severe CLL, such as abdominal pain, should also seek medical care.