Follicular lymphoma is a form of non-Hodgkin lymphoma. Follicular lymphoma is a type of cancer that scientists refer to as indolent, meaning it’s usually slow-growing. Follicular lymphoma is the most common type of indolent lymphoma in the United States. Non-Hodgkin lymphomas begin when a type of white blood cell — either a T cell or a B cell — begins growing abnormally. The cell divides repeatedly, making more abnormal cells that can then spread to other parts of the body by way of the lymphatic system. Follicular lymphoma arises in the B cells, which are responsible for producing antibodies, a type of protein that helps the immune system target and fight bacteria and viruses. (1) Follicular lymphoma accounts for about 1 in 5 cases of lymphoma in the United States. It is most common in older adults, with the average age of diagnosis being about 60. The disease is rare in young people. (3) Follicular lymphoma responds well to treatment, but it is difficult to cure. Since it is a slow-moving cancer, it may not need immediate treatment. Doctors and patients may choose a watch-and-wait approach, in which treatment is delayed until the disease causes problems. Follicular lymphoma has a five-year survival rate of 80 to 90 percent. This means that about 80 to 90 out of 100 people who have the disease will still be alive five years after being diagnosed. Many of these people live much longer than five years after receiving the diagnosis. (4) Lymph nodes are very small and generally hard to find, but when there’s an infection or cancer, they swell. Those that are near the body’s surface may get big enough to feel like lumps beneath the skin. Under a microscope, lymph nodes affected by follicular lymphoma show rounded structures resembling follicles. The swelling associated with follicular lymphoma often occurs in the neck, underarms, or groin. It is often painless and may remain over time, or the lymph nodes may shrink and then swell again. Oftentimes, this is the only symptom of follicular lymphoma. Follicular lymphoma is very slow-moving and often does not cause other symptoms until later stages of the disease. Other symptoms follicular lymphoma might cause are:
FeverUnexplained weight lossNight sweatsShortness of breath or chest painWeakness or fatiguePain or swelling in the abdomen
It’s important to note that symptoms will vary from person to person. How the disease manifests in one patient can be entirely different from how it affects another. Some people with follicular lymphoma may not experience any symptoms at all. (5) Age Follicular lymphoma is more common in people who are older, particularly those in their sixties. Family History People with a family history of non-Hodgkin lymphoma, especially those with a parent, child, or sibling with the disease, are more likely to get it themselves. Race When it comes to race and ethnicity, this type of lymphoma is more common in whites than in Asian-Americans and African-Americans. Immune Deficiency People with weakened immune systems are also at a higher risk of follicular lymphoma. Chemical Exposure Some research suggests that exposure to certain chemicals, including benzene and certain herbicides and insecticides (used to kill weeds and insects), may be linked to a higher likelihood of developing non-Hodgkin lymphoma. More research is needed to determine if there is actually a link. (6) The diagnosis itself is usually done with a lymph node biopsy. This is when either a small piece of a lymph node, or the entire lymph node, is removed from the body and sent to a lab for testing to determine if cancer is present. Physicians will also often perform other tests, such as blood tests, before a biopsy, to rule out other health issues, such as infections, since swollen lymph nodes are more often caused by infections than they are cancer. Other tests you might receive include imaging tests, like positron-emission tomography (PET) and computerized tomography (CT) scans, bone marrow aspiration and biopsy, and lumbar puncture (spinal tap). (7)
Stage 1 There is lymphoma in only one group of lymph nodes.Stage 2 The lymphoma is in two or more groups of lymph nodes in the body, close to each other.Stage 3 The lymphoma occurs in two or more groups of lymph nodes in the body that are far away from each other.Stage 4 This is the most advanced stage of lymphoma. In this stage, lymphoma cells have spread to at least one organ outside of the lymphatic system, such as the lungs, liver, or bone marrow.
Generally, stage 1 and some stage 2 lymphomas are considered early-stage. They are also sometimes referred to as “localized,” as they are located in one area or a couple areas close together. Stage 3 and stage 4 are considered advanced stages, as they are widespread. (8)
Watch and Wait If your case is slow-growing and not problematic, your doctors may opt to follow your for a period of time without treatment, a strategy known as “watch and wait” or active surveillance.Radiation Therapy This treatment uses high-energy X-rays to kill cancer cells. It’s typically performed with a carefully focused beam of radiation, delivered from a machine outside the body. (9)Chemotherapy Chemotherapy is the use of anti-cancer drugs, which may be taken orally or administered intravenously. These drugs enter the bloodstream and can reach almost all areas of the body. The most common chemotherapy regimens used against follicular lymphoma are: a four drug combination known by the acronym CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) plus the monoclonal antibody Rituxan (rituximab). (10)Stem Cell Transplants This treatment — in which cells that become healthy blood cells are collected from the patient or donors — restores bone marrow, which is where stem cells are made, after high doses of chemotherapy. This therapy is typically used in lymphoma patients who have relapsed after treatment. (11)Monoclonal Antibodies The immune system protects the body by attacking foreign substances that carry signals called antigens on their surfaces. Scientists can design antibodies in the lab that target cancer cells in a variety of ways, allowing the immune system to destroy them. Commonly used monoclonal antibodies used to treat follicular lymphoma include Rituxan (rituximab) and Gazyva (obinutuzumab).Radioimmunotherapy This is a combination of radiation therapy and treatment with monoclonal antibodies. A radioactive substance is linked to a monoclonal antibody and injected into the body. The antibody binds to cancer cells, bringing radiation therapy directly to the cancer cells. Zevalin (ibritumomab tiuxetan) is an example of a radioimmunotherapy used to treat follicular lymphoma. The drug is made up of a monoclonal antibody attached to a radioactive molecule. (12)Combination Therapies Sometimes more than one type of therapy will be used to treat lymphoma. These can include a combination of chemotherapy and radiation or radiation and antibodies, for example. Doctors will work with individual patients to help figure out the best treatment plan for them.
Even after complete remission, follow-up visits will be necessary to discuss any new or recurring symptoms and take any necessary tests. Follow-up appointments are important because lymphomas can sometimes come back even years after treatment. These appointments will be frequent at first, usually every few months in the first year and then gradually less often over time. (13) Treatment for lymphoma can increase your risk of other chronic health conditions, such as heart disease, kidney disease, diabetes, lung disease, and thyroid disease. It can also raise the risk of a second cancer. Chemotherapy and radiation therapy increase that risk further. (14)
