One kind of non-Hodgkin lymphoma that might appear suddenly is follicular lymphoma. To assist diagnose this problem, your doctor might prescribe diagnostic imaging, blood tests, and a biopsy.
The malignancy known as follicular lymphoma starts in B cells, which are white blood cells produced in the bone marrow. When B cells come into contact with bacteria, viruses, or other pathogens, they develop and become active in the lymph nodes throughout your body after traveling via the circulation.
Cancerous B cells in follicular lymphoma group together to form “follicles,” which are clusters in the lymph node that mimic bundles of healthy immune cells. This is the origin of the term “follicular lymphoma.”
In the US, there are about 2.4 new cases of follicular lymphoma for every 100,000 persons annually. It has good survival rates because it is a slow-growing malignancy. The 5-year relative survival rate for follicular lymphoma at its earliest stage is approximately 97%.
How is follicular lymphoma diagnosed?
When they see a swollen lymph node that doesn’t ache but tends to come and go, the majority of patients with follicular lymphoma go to their doctor.
The most often impacted lymph nodes are those in the neck, groin, abdomen, and underarms. These bodily parts frequently have obvious lumps, which makes a trip to the doctor necessary.
But not everyone experiences a noticeable enlargement of the lymph node. Follicular lymphoma may affect the 800 or so lymph nodes in your body that are invisible to the naked eye.
When there isn’t a lump, you may still need to see a doctor for follicular lymphoma symptoms like fever, weight loss, excessive exhaustion, and night sweats.
Your doctor will evaluate your symptoms and risk factors for diseases like follicular lymphoma following a preliminary physical examination and assessment of your medical history.
The following factors may increase your risk of follicular lymphoma:
- have an over-60-year-old family member with the illness who has been exposed to specific chemicals and illnesses
Tests and diagnostic processes your doctor will recommend
The testing for follicular lymphoma is based on your medical history and symptoms. Some tests may be necessary to help rule out other medical issues, or you may not require all of them.
Physical exam
The physical examination occurs during your first visit to the doctor. Your doctor examines your weight, baseline neurologic and motor performance, and vital indicators like respiration and heart rate.
They will use gentle touch to examine your lymph nodes. Usually measuring less than 1 to 2 centimeters (cm), a lymph node is small.
Blood tests
A sample of your blood is used in blood tests to measure things like the number of blood cells, proteins, and enzymes.
These tests can tell your doctor about the growth and spread of cancer and offer them a general picture of how your organ systems are doing.
Your doctor may prescribe the following tests:
- Complete blood count (CBC): This looks at platelet, white blood, and red blood cell counts.
- Chemistry panel: This provides information into organ function by measuring enzymes, lipids, proteins, glucose, and electrolytes.
- Lactate dehydrogenase (LDH) test: This quantifies LDH, an enzyme that can reveal tissue damage from diseases like cancer.
- Beta-2 microglobulin test: When B cells undergo rapid cell turnover, like that caused by cancer, a protein on their surface called beta-2 microglobulin is released into the bloodstream.
Biopsy
One of the primary diagnostic procedures for follicular lymphoma is a lymph node biopsy. Your physician will remove cells from inside your lymph node using a needle so they can be examined under a microscope. Sometimes a biopsy removes the entire lymph node.
Your lymph node tissue is examined by pathologists at the microscopic level. They search for traits that are specific to follicular lymphoma, such as abnormal B-cell structure and clusters of malignant B-cells.
Diagnostic imaging
Doctors can use diagnostic imaging to help them establish the follicular lymphoma stage. Your physician can see parts of your body that are otherwise invisible thanks to CT and PET scans.
These scans are carried out by a radiologist with specialized equipment. To help draw attention to areas of inflammation or malignant alterations, you might have a dye injected into your vein.
Doctors can monitor the effectiveness of treatment and determine the size and extent of follicular lymphoma with the use of diagnostic imaging.
Bone marrow test
When it’s vital to ascertain whether follicular lymphoma has involved—or spread—to your bone marrow, your doctor suggests a bone marrow test. Up to 70% of patients with the disease have bone marrow involvement, which is a sign of a more advanced stage of the cancer.
Stage
Your doctor uses the Ann Arbor staging system and the Lugano Classification to stage follicular lymphoma once all of your diagnostic tests are finished.
- Stage 1: involvement of one lymph node or a collection of nearby lymph nodes.
- Stage 2: involvement of two or more lymph node clusters on the diaphragm muscle’s same side.
- Stage 3: involvement of lymph nodes above the diaphragm with spleen involvement or involvement of lymph nodes on both sides of the diaphragm.
- Stage 4: involvement of several lymph nodes, affecting the bone marrow and other organs.
To incorporate information regarding your diagnosis, your doctor might write the letters “A, B, or X” on your stage.
- A: This means that there is no fever, night sweats, or noticeable weight loss.
- B: This indicates the presence of fever, nocturnal sweats, or severe weight loss.
- X: This indicates that the lymphoma is more than 10 cm in size.
What happens after a diagnosis?
After being diagnosed with follicular lymphoma, your next course of action should be to completely comprehend the disease and choose a treatment plan.
In the early stages of follicular lymphoma, physicians may choose to wait and see. This is referred to as “watchful waiting” or “active surveillance.” If the adverse effects of the treatment are worse than the cancer at this stage, your doctor will advise this.
In follicular lymphoma, those treated with careful waiting fare as well as those who receive cancer treatments early.
As the illness progresses, physicians will advise beginning therapies such as:
- radiation treatment
- targeted treatments such as chimeric antigen receptor T-cell (CAR T) therapy or monoclonal antibody therapy
Talking with your care team
Receiving a diagnosis of follicular lymphoma can be overwhelming, despite the fact that it is a slow-growing malignancy with good survival rates. It’s totally natural to have questions and worries or just need room to process. Your medical staff is here to help you at every stage and treat the cancer.
Your worries and inquiries are quite legitimate. You may wish to talk to your doctor about the following subjects:
- What does my follicular lymphoma stage mean?
- How frequently will I require more tests?
- Which therapies would you suggest, and why?
- Do I need to think about a clinical trial?
- Will my daily routines or life be impacted by this diagnosis?
- What options are accessible for emotional support or mental health?
Takeaway
One kind of non-Hodgkin lymphoma that grows slowly and may not exhibit any symptoms at first is follicular lymphoma. Many people receive their initial diagnosis after seeing a doctor about a large, painless lymph node.
To confirm follicular lymphoma, your doctor will prescribe diagnostic tests following a physical examination. You might require imaging scans, a bone marrow test, a biopsy, or blood testing.