Patient education: Follicular lymphoma (The Basics)

What is follicular lymphoma? — Follicular lymphoma is a type of lymphoma. Lymphoma is cancer of the lymphatic system. The lymphatic system is made up of organs all over the body that make and store cells that fight infection (figure 1). These infection-fighting cells are also called "white blood cells."

When people have follicular lymphoma, their white blood cells become abnormal and grow out of control. These cells can travel to different parts of the body. Often, the abnormal cells collect in bean-shaped organs called lymph nodes. This causes the lymph nodes to swell.

Follicular lymphoma usually grows slowly, but it can change to a type of lymphoma that grows quickly.

What are the symptoms of follicular lymphoma? — Most people with follicular lymphoma first notice 1 or more swollen lymph nodes. These swollen nodes are often in the neck, groin, or belly. People can feel them under the skin, but they are usually not painful.

Other than having swollen lymph nodes, some people do not have any other symptoms for years. But other people can have symptoms, including:

●Fever

●Weight loss

●Night sweats that soak the clothes

●Pain

●Blockages in the digestive tract or urinary tract

●Feeling very tired and weak

Is there a test for follicular lymphoma? — Yes. Your doctor or nurse will talk with you and do an exam. They will also do:

●Blood tests

●Lymph node biopsy – A doctor removes one of the swollen lymph nodes. Then, another doctor looks at the cells under a microscope to see if cancer cells are present.

What is lymphoma staging? — Lymphoma staging is a way in which doctors find out how far the lymphoma has spread in the lymphatic system or in the rest of the body.

To find out how far your follicular lymphoma has spread, your doctor will do an exam, blood tests, and an imaging test, such as a CT or PET scan. Imaging tests create pictures of the inside of the body.

Your doctor might also do a bone marrow biopsy. For this test, a doctor takes a small sample of bone marrow (the tissue in the center of your bones). Another doctor looks at the sample under a microscope to see if it has cancer.

How is follicular lymphoma treated? — Often, follicular lymphoma is not treated right away. Your doctor might not treat your follicular lymphoma right away if it is not causing any symptoms. But they will watch your cancer closely by doing exams and blood tests until treatment is needed.

Doctors usually treat follicular lymphoma when it causes symptoms. Treatments can help reduce symptoms, but they do not usually cure the cancer. The right treatment for you will depend on:

●Your symptoms

●Where the follicular lymphoma is in your body

●Your age and other medical conditions

People with follicular lymphoma can be treated with:

●Chemotherapy – Chemotherapy is the medical term for medicines that kill cancer cells or stop them from growing.

●Antibodies – Antibodies are proteins in blood. The immune system makes them to help the body fight infections. But there are other types of antibodies that are created in a lab and used as medicine. They kill cancer cells by targeting specific parts of the cells.

●Radiation therapy – Radiation kills cancer cells.

What happens after treatment? — After treatment, you will be checked every so often to see if the cancer comes back. Regular follow-ups will include talking with your doctor and having exams. Sometimes, your doctor will also do blood tests and imaging tests.

Watch for the symptoms listed above, such as swollen lymph nodes, fever, weight loss, or night sweats. Tell your doctor or nurse if you have those symptoms, because this could mean that the cancer has come back.

What happens if the follicular lymphoma comes back? — If the follicular lymphoma comes back, your doctor might recommend trying a different treatment.

Depending on your age, health, and preferences, treatment might include:

●Chemotherapy

●Antibodies

●Bone marrow transplant – This treatment replaces cells in your bone marrow that are killed by chemotherapy or radiation.

●"CAR-T" therapy – CAR-T therapy uses your own immune cells, called "T cells," to kill the cancer cells. The T cells are collected, modified, and returned to your body. The modified T cells then directly target the cancer cells.

What else should I do? — Follow all of your doctor's instructions about visits and tests. It's also important to talk to your doctor about any side effects or problems you have during treatment.

Getting treated for follicular lymphoma involves making many choices, such as what treatment to have and when. Always let your doctors and nurses know how you feel about a treatment. Any time you are offered a treatment, ask:

●What are the benefits of this treatment? Is it likely to help me live longer? Will it reduce or prevent symptoms?

●What are the downsides to this treatment?

●Are there other options besides this treatment?

●What will happen if I do not have this treatment?

More on this topic

Patient education: Lymphoma (The Basics)
Patient education: Autologous bone marrow transplant (The Basics)
Patient education: Allogeneic bone marrow transplant (The Basics)
Patient education: Bone marrow aspiration and biopsy (The Basics)

Patient education: Follicular lymphoma in adults (Beyond the Basics)
Patient education: Hematopoietic cell transplantation (bone marrow transplantation) (Beyond the Basics)