Further tests give the doctors more information about the exact type of chronic lymphocytic leukaemia and how it is likely to respond to treatment. Tests on the blood or bone marrow include:

• Immunophenotyping where samples are examined to see exactly which white blood cells are abnormal. The types of white blood cell are identified by looking at particular proteins which are found on the surface of the cells.
• Cytogenetic testing where the chromosomes in the leukaemia cells are studied. Chromosomes are made up of genes and these control the activity of the cell. There are often changes in the chromosomes in people with CLL and finding exactly what those changes are helps the doctor to know how best to plan treatment. It can also give an indication of how well the leukaemia may respond to treatment.
• Tests to look at the levels of antibodies in the blood and whether particular proteins are present that may damage the red blood cells.

Occasionally, it may be necessary to remove an enlarged lymph gland to look at the cells under a microscope. This is called a lymph node biopsy and may be done under a local or general anaesthetic. It is a small operation, during which the whole gland is removed and sent to the laboratory. Most people can go home on the same day. After the surgery, you will have a small wound with a few stitches. The stitches are usually taken out after about 7-10 days.

A chest x-ray is usually taken to check that your lungs are healthy. You may also have a CT scan to see how many of your lymph glands are affected by the CLL and whether your spleen is enlarged. A CT scan is a type of x-ray which uses a computer to build up a 3D picture of the inside of the body. It takes up to 10-15 minutes. You can usually go home once the scan is over.

It will probably take several days for the results of your tests to be ready, and this waiting period will obviously be an anxious time for you. It may help if you can talk things over with a close friend, relative, or a support organisation.

CLL is a chronic disease. This means that it develops (progresses) slowly, usually over many years. In its early stage, you may not have any symptoms at all, and your doctor may just monitor your condition. This is the case for many people, especially if the CLL was discovered during a routine blood test.