Expert Explains How CLL Differs From Solid Tumor Cancers

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Andrew Schorr:

So, Phil, let's understand. What is the rationale among you CLL specialists why not to treat on day one?  How come?  

Dr. Thompson:

Yeah, so I think that the idea that you need to get cancer early, treated early comes mainly from solid tumors.  And so if for example you have bowel cancer and you discover it when it's small and it's localized to the intestine, then you can surgically remove it and you're done. Never have to have any treatment other than that initial operation, because it's only located in the one place. 

Now, CLL is a very different beast because at the earliest stages of the disease it's everywhere in your body.  It's circulating around in the blood.  It's within lymph nodes.  It's within lymphatic tissue that's present in organs in your body.  It's in the bone marrow.  So there's no quick fix that you can do at that early stage so that it's gone forever and you don't have to worry about it.  

So with a few exceptions what you're doing is managing a chronic disease.  And so when you're managing a chronic disease you have to weigh off I guess the risks of treating the disease and toxicities that are associated with treatment versus the risks of doing nothing.  And sometimes for patients, well, very often for patients with very early?stage CLL you can watch them for many years.  They don't have any symptoms related to the disease.  The disease is not causing them any harm. And if I were to give a treatment to that patient that would have a—that they could potentially have a significant side effect I may be doing more harm than good by doing that.  

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.