Follicular Lymphoma

Follicular Lymphoma
Follicular lymphoma in spleen,
AFIP Atlas of Tumor Pathology

Follicular lymphoma is classified as a Non-Hodgkin's Lymphoma. It is an indolent (slow-growing) cancer that affects B-Cell Lymphocytes. Like most lymphomas, it usually begins in the lymph nodes; it can spread into the blood and bone marrow, as well as the internal organs. The liver and spleen may also be affected.

Follicular lymphoma accounts for a high percentage of B-Cell Lymphomas. Approximately 20-30% of cases of NHL are diagnosed as Follicular Lymphoma. Most of these diagnoses occur in adults over the age of 60, with an equal occurrence in males and females.

Diagnosis and Staging of Follicular Lymphoma

Most patients with Follicular Lymphoma will have little to no symptoms until the later stages of the disease because it is indolent. Symptoms include painless, swollen lymph nodes in the neck, armpit, or groin, fever, fatigue, night sweats, and unexplained weight loss.

If the doctor suspects cancer, he will conduct a biopsy on an affected lymph node. A chest X-ray, CT or PET scan, or other diagnostic tests may also be ordered to help stage the disease.

Stage I
Marked by the involvement of only one group of lymph nodes or one section of organ tissue.
Stage II
The disease has spread to two lymph groups on the same side of the diaphragm, or to a lymph group and nearby organ.
Stage III
The disease includes lymph nodes on both sides of the diaphragm.
Stage IV
The disease involves multiple internal organs, including the liver, bone marrow, and blood.

Follicular lymphoma is also divided into three grades, based on the ratio of large to small B-cells affected.

Grade 1
Cancer is made up of all small cells.
Grade 2
Cancer is a mixture of large and small cells.
Grade 3
Cancer affects mostly large cells; generally more aggressive.

Even though most patients are diagnosed in later stages of the disease, prognosis is still good. There is a 70% chance of survival at the ten-year mark.

Treatment of Follicular Lymphoma

Treatments vary based on the stage of the disease. Luckily, follicular lymphoma is very sensitive to both radiation and chemotherapy, so treatment is highly effective. Methods include:

  • Radiation treatment, especially in earlier stages of the disease (Stage I and II).
  • Chemotherapy regimens, like the CHOP protocol (cyclophosphamide, doxorubicin, vincristine, and prednisone).
  • Monoclonal antibodies such as Rituximab, Bexxar, or Zevalin.
  • Combined regimens, especially the R-VCP protocol. This uses the monoclonal antibody rituximab, along with chemotherapy agents cyclophosphamide and vincristine. Prednisone, a steroid, is used to help prevent internal swelling and keep organs healthy while on this regimen.
  • Stem Cell Transplant is used in patients with relapsed lymphoma.
  • The wait and watch method is used for patients who are diagnosed but aren't presenting symptoms. This method has the same survival rate as patients who are treated before symptoms present. Once a patient shows common symptoms of the disease, treatment is administered.

Cited for Reference

Indolent Follicular Lymphoma fact sheet from the Lymphoma Research Foundation

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