Follicular lymphoma is a type of cancer that begins in lymphocytes, a type of white blood cell in the immune system. This condition falls under the broader category of non-Hodgkin lymphoma. It develops when these cells grow and divide uncontrollably within the lymphatic system.
Understanding Follicular Lymphoma
Follicular lymphoma is a common form of non-Hodgkin lymphoma, known for its generally slow-growing or “indolent” nature. It originates from B-lymphocytes, which are a type of white blood cell that normally resides in structures called follicles within lymph nodes. The cancer cells in follicular lymphoma tend to form these characteristic follicle-like patterns when observed under a microscope, which gives the disease its name.
While it is often widespread throughout the body at diagnosis, commonly affecting multiple lymph node sites, bone marrow, and sometimes other organs, its slow growth means symptoms may develop gradually. Approximately 20% to 30% of all non-Hodgkin lymphoma cases are follicular lymphoma.
Recognizing the Signs
Follicular lymphoma often presents without noticeable symptoms in its early stages. However, the most common visible sign is the development of one or more painless swollen lymph nodes. These lumps are frequently found in areas such as the neck, armpit, or groin, where lymph nodes are closer to the skin’s surface. The swelling occurs as lymphoma cells accumulate within these nodes.
Other potential symptoms, sometimes referred to as ‘B symptoms,’ can include unexplained weight loss, fevers above 38ºC, and drenching night sweats. Patients may also experience persistent fatigue not relieved by rest, or frequent infections. While these symptoms can indicate various conditions, their presence, especially if persistent, warrants medical evaluation.
Diagnosing Follicular Lymphoma
Diagnosing follicular lymphoma involves several steps to confirm the presence of cancer and determine its extent. A physical examination helps identify swollen lymph nodes or other affected areas. Blood tests are routinely performed to assess overall health and may reveal abnormal blood cell counts. Although there is no specific blood test for lymphoma, these tests provide important baseline information.
Imaging scans, such as computed tomography (CT) and positron emission tomography (PET) scans, provide detailed pictures of the body’s interior. These scans help doctors locate areas where lymphoma cells are active, determine the size and spread of the disease, and monitor treatment progress. A biopsy, specifically a lymph node biopsy or bone marrow biopsy, is the definitive method for diagnosis. A tissue sample is removed and examined by a pathologist under a microscope to identify characteristic features of follicular lymphoma.
Managing Follicular Lymphoma
Due to its generally slow-growing nature, management of follicular lymphoma can vary significantly among individuals. For some patients with no or minimal symptoms, a “watch and wait” approach, also known as active surveillance, may be recommended rather than immediate treatment. This involves regular monitoring through physical examinations, laboratory tests, and imaging scans to track the disease’s progression. Studies indicate that patients managed with this approach can have similar overall survival outcomes compared to those treated early.
When treatment becomes necessary, plans are individualized based on factors like symptoms, disease progression, and patient health. Common treatment options include chemotherapy and immunotherapy, often involving monoclonal antibodies. Radiation therapy may be used for localized disease, sometimes providing long-lasting remission. Targeted therapies are also part of the treatment landscape.
Long-Term Outlook
Follicular lymphoma is often considered a chronic condition that can be managed for many years, though it is generally not considered curable. Despite being incurable, most people respond well to treatment, and many live long lives with proper medical care. The five-year survival rate for follicular lymphoma is approximately 80% to 90%, with half of patients living for about 10 to 12 years or even longer.
The disease is often described as “relapsing-remitting,” meaning symptoms may subside after treatment but can return later. This characteristic necessitates ongoing monitoring and follow-up care to manage potential relapses. While transformation to a more aggressive form can occur in a small percentage of cases, advancements in treatment continue to improve the long-term outlook for many individuals.