Follicular Lymphoma

The average age of diagnosis for follicular lymphoma is about 55, but it can develop earlier and later in life..

Follicular lymphoma is a common type of non-Hodgkin Lymphoma (NHL). It is a slow-growing lymphoma that arises from B-cells, a type of white blood cell. It is also called an indolent or low-grade lymphoma for its slow nature, both in terms of its behavior -- slower growth -- and how it looks under the microscope -- less abnormal than high-grade malignancies.

To learn more about symptoms, risk factors and how follicular lymphoma fits into the big picture of lymphomas, follow the link to a related article.

Who it Affects

Follicular lymphoma mainly affects older adults. The average age at diagnosis is about 55. Men and women are nearly equally affected. Younger adults can be affected, however. For instance, read the survival story of Juliana Fuller, who was diagnosed with follicular lymphoma at age 26. Now a new Mom, she serves as an Ambassador for the Lymphoma Research Foundation is committed to providing hope to all those affected by lymphoma.  

Signs and Symptoms of Follicular Lymphoma

Follicular lymphoma is subtle, with minor warning signs that often go unnoticed for a long time. Enlargement of lymph nodes is a common symptom. Fever, weight loss, sweating, and fatigue are other symptoms of lymphoma.

How it is Diagnosed

Follicular lymphoma is diagnosed with a lymph node biopsy. A small sample of the affected node is taken and seen under the microscope by a pathologist. The features of the affected node suggest the presence of a lymphoma.

After lymphoma diagnosis, the sample goes through other tests to detect the presence of markers that aid in determining prognosis and treatment.

Why It's Called 'Follicular' Lymphoma

Like most lymphomas, follicular lymphomas mainly affect lymph nodes. When the lymph nodes affected by this lymphoma are seen under the microscope, they show rounded structures called "follicles." The lymphoma is therefore called follicular lymphoma.

Tests After Diagnosis

A number of tests are required when follicular lymphoma is first diagnosed. These allow the doctor to see the exact extent of the disease and which organs are affected. Blood tests, CT scans and bone marrow tests are required as a routine. These tests are required for staging of lymphoma and to determine the prognosis and treatment approach. Newer research has also explored the utility of PET/CT scans for follicular lymphoma, for instance, when results of a CT scan are unclear. In PET-CT, a radioactive tag (18F-fluorodeoxyglucose) is injected into the patient before the CT scan, and areas of active disease light up if they take up the radioactive glucose.

Staging and Prognosis:

The stage of follicular lymphoma indicates the extent to which the disease has spread. Lymphoma spreads to lymph nodes as well as other organs in the body including the bone marrow. There are four stages of lymphoma. The stage and various other factors determine the prognosis of follicular lymphoma.

Prognosis is calculated with the FLIPI index.

A Slow-Growing Cancer:

Follicular lymphoma is a slow-growing disease. It often remains unnoticed for a long time in the body before it is diagnosed. As the symptoms are subtle, the disease is often advanced before a diagnosis is made. Most individuals are diagnosed in stage III or IV. However, even in advanced stages there is no immediate threat to life. The disease has a "waxing and waning" course, meaning that it flares up and regresses a number of times over years. Even though none of the treatments are curative in advanced stages, many patients survive for 8 to 10 years or more with treatment.

Treatment:

A number of treatment options exist for follicular lymphoma. In early stages of the disease, radiation therapy can work very well. In the more advanced stages, the treatment depends on the extent of disease and the symptoms of the patient. Some individuals with few or no symptoms and stable disease may be observed, without treatment, until the disease shows signs of progression. For others, the treatment is chemotherapy. Chemotherapy drugs may be taken by mouth or as injections. Monoclonal antibody therapy with Rituximab has also been approved for treatment of follicular lymphoma.

Updated January 2016, TI.

Sources:

NCCN Clinical Practice Guidelines in Oncology. Version 2.2015.

Leibel and Phillips Textbook of Radiation Oncology: Expert Consult; Hoppe R, et al.

Trotman J, Fournier M, Lamy T, et al. Positron emission tomography-computed tomography (PET-CT) after induction therapy is highly predictive of patient outcome in follicular lymphoma: analysis of PET-CT in a subset of PRIMA trial participants. J Clin Oncol 2011;29:3194-3200.

Lymphoma: Pathology, Diagnosis, and Treatment. 2013; Robert Marcus, et al.

Flinn IW, van der Jagt R, Kahl BS, et al. Open-label, randomized, noninferiority study of bendamustine-rituximab or R-CHOP/R-CVP in first-line treatment of advanced indolent NHL or MCL: the BRIGHT study. Blood 2014;123:2944-2952.

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