Follicular Lymphoma

What Is Follicular Lymphoma?

Follicular lymphoma is a cancer that affects white blood cells called lymphocytes. They help your body fight infections.

There are two types of lymphomas: Hodgkin's and non-Hodgkin's, based on the kind of white blood cell they affect. Follicular lymphoma is a non-Hodgkin's lymphoma.

When you have follicular lymphoma, the sick blood cells can travel to many parts of your body, such as your organs, bone marrow, and lymph nodes (pea-sized glands in your neck, groin, and under your arms that are part of your immune system). The blood cells can form tumors in these places.

Although follicular lymphoma usually can't be cured, you can live long and well with it. This cancer grows slowly. You may not need treatment for many years, or ever. But if you do, it usually works well. Many people live disease-free afterward.

Causes

Doctors don't know what causes follicular and other non-Hodgkin's lymphomas. Unlike some cancers, they are not passed down in families. In some cases, radiation or cancer-causing chemicals, or certain infections, may be a cause. But other times there is no known cause.

You are more likely to get follicular lymphoma as you age. People are 60 years old, on average, when diagnosed.

You're also mmay be at an increased risk to get the disease if you have HIV, rheumatoid arthritis, lupus, or celiac disease, which are all immune system disorders.

Symptoms

You may have no symptoms of follicular lymphoma.

If you do have symptoms, you may have:

• Painless swelling of the lymph nodes in your neck, groin, stomach, or armpits
• Shortness of breath
• Fatigue
• Night sweats
• Weight loss

Getting a Diagnosis

First, your doctor will do a physical exam and ask you questions like:

• Have you had a lump in your neck, groin, stomach, or armpits? Was it painful? Did it go away and come back?
• Have you ever been diagnosed with cancer? How was it treated?
• Have you been exposed to any cancer-causing chemicals on the job?
• Have you been diagnosed with HIV, rheumatoid arthritis, lupus, or celiac disease?
• Have you had an organ transplant?

Questions for Your Doctor

• Are there any other tests I should have before we decide on treatment?
• What is the stage of my follicular lymphoma and what does it mean?
• Does it need to be treated right away?
• What treatment do you recommend? Why?
• What are the side effects of this treatment?
• How will it affect my daily life?
• How likely is my follicular lymphoma to come back after this treatment?
• What will we do if it does come back?

You may want to ask your doctor if you can take part in a clinical trial. These test new drugs to see if they are safe and if they work. They often are a way for people to try new medicine that isn't yet available to everyone. Your doctor can tell you if one of these trials might be a good fit for you.

Treatment

If you have no symptoms, your doctor may decide just to watch you closely. This is called "watchful waiting." Studies show it works as well as early treatment.

Your doctor may advise starting treatment if:

• Your lymph nodes keep getting larger
• You have a fever or night sweats
• You are losing weight
• You have low blood counts

After treatment, many people stay disease-free for years, although the cancer usually returns. Over time, 30% to 40% of follicular lymphomas behave like or turn into other forms of lymphoma that grow faster and need intensive treatment.

If you do need treatment, it may include one or more of the following:

Radiation. It kills cancer cells.The radiation comes from a high-energy beam, similar to an X-ray, or from material put inside your body in or near the cancer.

Follicular lymphoma responds well to radiation. In some cases, it can cure the cancer. If yours is at an early stage, you may only need radiation. If it's advanced, you may get other treatments as well.

Monoclonal antibodies. These are drugs that act like your body's disease- fighting cells. For most people, rituximab (Rituxan) and obinutuzumab (Gazyva) works well to kill lymphoma cells while doing little damage to normal body tissues. It also has fewer side effects than chemotherapy.

Taking Care of Yourself

It's normal to have mixed feelings: happy that you're not having symptoms or are disease-free after treatment, but worried about what might happen in the future.

Despite the uncertainty, you can have a full life. These tips may help:

Don't try to ignore whatever fears you have. Let yourself feel them and then practice letting them go. Talking about them to a friend or counselor often helps.

Focus on what you can do to be healthy now. Exercise, eat a balanced diet, and make any other changes that would help take better care of yourself. This helps you feel better and have more sense of control.

Spend some peaceful time every day. This can be helpful even if it's just for a few minutes. When you are stressed out, summon up that feeling.

What to Expect

With follicular lymphoma, time is on your side. It grows slowly, and new and better treatments are helping people live disease-free for longer periods of time.

Most people respond well to treatment -- not just the first time, but if it comes back. Stay informed and talk to your doctor about all your treatment options and the clinical trials that might be helpful for you.

Getting Support

The Lymphoma Research Foundation offers many resources on treatments, research advances, clinical trials, and ways to cope with follicular lymphoma. These include one-on-one peer support and financial aid programs.

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