Follicular Lymphoma - Symptoms, Causes and Treatment

Follicular lymphoma is a type of non-Hodgkin lymphoma (NHL) that arises from B-cells, a type of white blood cell. It is characterised by the abnormal growth of lymphocytes in the lymph nodes and other lymphoid tissues.
Follicular lymphoma is typically indolent (slow-growing) and considered a low-grade lymphoma.

Follicular lymphoma chromosomal translocation arises from B-cells, which are a type of white blood cell. The presence of a specific chromosomal translocation characterises it.
The translocation involves a rearrangement between chromosomes 14 and 18. 

When a patient has follicular lymphoma, the body's organs, bone marrow, and lymph can all get infected. Because of this, tumours can develop.
Follicular lymphoma often has no cure. However, it is possible to live a long and healthy life with it. 

This cancer spreads gradually, and the patient might not require therapy for a very long time or ever. After treatment, a lot of patients experience long-term remission.

To determine the type of treatment that may be most effective to treat the disease, healthcare professionals study the cancer stages.
The important follicular lymphoma classification span from stages I to IV:

1. Stage I: In this stage, one or more lymph nodes have cancer. Approximately 25% of all cases of follicular lymphoma are diagnosed at this stage by medical professionals. 

2. Stage II:  In this stage, cancer is found in the areas above or below the diaphragm. At this stage, medical professionals diagnose 15% of all follicular lymphoma cases.

3. Stage III: Cancer is found in lymph nodes on both sides of your diaphragm. Approximately 26% of all follicular lymphoma cases are diagnosed at this stage by healthcare professionals.

4. Stage IV: Cancer is found to have spread out from the lymph nodes to bone marrow and/or other organ systems. Approximately 27% of all follicular lymphomas are diagnosed at this stage by medical professionals.

Follicular Lymphoma Grades

According to the World Health Organization's (WHO) grading system, follicular lymphoma is grated into grades 1 to 3.
This grading scheme is based on the number of enlarged B cells appears under a microscope. 

Scientific evidence suggests that the likelihood of developing follicular lymphoma increases if one has a higher number of enlarged B cells in the body.
It can also further develop into  a more aggressive type of non-Hodgkin’s lymphoma called diffuse large B-cell lymphoma.

About 25% and 35% of follicular lymphoma develop into diffuse large B-cell lymphoma.

The grades of follicular lymphoma include.

1. Grade 1 Follicular Lymphoma: It is theleast aggressive variety of follicular lymphoma. A doctor diagnoses grade 1 follicular lymphoma if the count is 0 to 5 centroblasts per high power field (HPF).
   It’s also called follicular small cleaved cell lymphoma.

2. Grade 2 Follicular Lymphoma: Grade 2 follicular lymphoma is also known as follicular mixed-cell lymphoma.
   It is characterised as follicular lymphoma with 6 to 15 centroblasts per HPF. 

3. Grade 3 Follicular Lymphoma: More than 15 centroblasts per HPF indicates that a patient has grade 3 follicular lymphoma, also known as follicular large cell lymphoma. 

According to its features, the WHO classified grade 3 follicular cancer into two subcategories:

1. Grade 3A: It is characterized by the presence of diffuse areas within the lymph node biopsy.
   This means that instead of the usual follicular pattern seen in grade 1 and grade 2 follicular lymphoma, there is a more disorganized and diffuse growth of cancer cells.

2. Grade 3B: It is characterized by a predominantly diffuse growth pattern of cancer cells, with little or no residual follicular pattern observed in the lymph node biopsy.

Patients may exhibit signs of follicular lymphoma years after being diagnosed because os slow growth. Some follicular lymphoma patients may not exhibit symptoms, especially at first. When they appear, symptoms are frequently comparable to those of less serious illnesses. 

Aggressive follicular lymphoma frequently results in new, aggravating symptoms, such as the spread of the disease to additional body parts.

The general symptoms of follicular lymphoma include 

1. Enlarged lymph nodes in the neck, armpit, or groyne.

2. Fever brought on by an infection or another sickness.

3. Sudden weight loss, where the patient has lost 10% or more of the body weight in the last six months.

4. Night sweats and persistent chills.

5. Feeling of being too exhausted to handle the daily tasks.

The exact causes of follicular lymphoma are unknown. They are not genetically inherited, unlike certain other cancers.
It is believed that environmental and immunological factors and certain genetic mutations may cause follicular lymphoma to develop.

Follicular Lymphoma Risk Factors 

A risk factor is anything that increases the patient’s chance of getting a disease like cancer. Different cancers have different risk factors. 

However, having a risk factor, or even many risk factors, does not mean that the patient will get the disease. And many people who get the disease may have few or no known risk factors.

 Follicular lymphoma risk factors include the following:

1. Immune System Suppressing Medications: The patient may be more susceptible to follicular lymphoma if they've undergone an organ transplant and take immunosuppressive medications. 

2. Infection: Specific bacterial and viral infections increase the risk of follicular lymphoma. HIV and Epstein-Barr infection are two viruses associated with this malignancy. 
   The infectious pathogen might start a long-lasting inflammatory response and promote B lymphocyte transformation.

3. Exposure to Chemicals: Some herbicides, such as those used to eliminate weeds and insects, may increase the risk of acquiring follicular lymphoma.
   According to studies, people who are exposed to benzidine, mineral, cutting, or lubricating oil, pesticides, and herbicides have a higher risk of developing follicular lymphoma.

4. Old Age: Although follicular lymphoma can develop at any age, the risk rises with advancing years. People 60 and older are most likely to experience it.
   This is because managing follicular lymphoma, becomes impossible with fragility and other illnesses that occur with age.

5. Alcohol Consumption: Alcohol consumption is known to be a causative effect inducing cancer in humans.
   Wine consumers have an increased risk of developing follicular lymphoma as alcohol leads to immunosuppression, and the patients get affected easily with the disease.

6. Smoking: The chemicals in tobacco smoke can create genetic changes that allow lymphocytes to multiply uncontrolled.
   Nearly 5% to 6% of smoking individuals with follicular lymphoma had mutations in this gene.

Preventing follicular lymphoma is challenging because the exact cause of the disease is unknown.
However, there are some general lifestyle recommendations that may help reduce the risk of developing not only follicular lymphoma but also other types of non-Hodgkin lymphoma (NHL):

1. Maintain a Healthy Lifestyle: A healthy lifestyle can enhance general wellbeing and possibly lower the chance of cancer development. This involves keeping a healthy weight, exercising frequently, eating a balanced diet, and abstaining from smoking and drinking too much alcohol.

2. Protection from Viral Infections: Follicular lymphoma and other viral infections have been linked to an elevated chance of developing NHL.
   Practise safe sex, be vaccinated against hepatitis B and the human papillomavirus (HPV), and take the necessary steps to avoid HIV infection to lower the risk of contracting these infections.

3. Minimize Exposure to Environmental Toxins: Despite the lack of clarity on the connection between environmental pollutants and follicular lymphoma, it is wise to limit exposure to certain carcinogens.
   When at all possible, prevent or reduce exposure to chemicals, pesticides, solvents, and other environmental hazards.

4. Maintain a Strong Immune System: An immune system that is functioning properly can fend off cancerous cells and stop the growth of lymphomas.
   Take measures to strengthen the immune system by obtaining enough sleep, controlling stress, and practising excellent hygiene to avoid infections.

Diagnosing follicular lymphoma typically involves a combination of medical history evaluation, physical examination, and various diagnostic tests.
The following are commonly used diagnostic methods for follicular lymphoma:

1. Biopsy: A biopsy is the most definitive method for diagnosing follicular lymphoma. It involves the removal of a small tissue sample from a lymph node or other affected areas.
   The tissue is then examined under a microscope by a pathologist to determine the presence of abnormal lymphocytes characteristic of follicular lymphoma.

2. Imaging Tests: Imaging tests such as computed tomography (CT) scans, positron emission tomography (PET) scans, and magnetic resonance imaging (MRI) scans are used to evaluate the extent and location of the lymphoma.
   These tests help determine the stage of the disease and aid in treatment planning.

3. Blood Tests: Blood tests may be conducted to evaluate blood cell counts, including white blood cells, red blood cells, and platelets.
   These tests can provide information about the overall health status and identify any abnormalities that may be associated with follicular lymphoma.

4. Bone Marrow Biopsy: In some cases, a bone marrow biopsy may be performed to determine if the lymphoma has spread to the bone marrow.
   This procedure involves the removal of a small sample of bone marrow from the hipbone, which is then analysed under a microscope for the presence of abnormal cells.

5. Genetic Testing: Genetic tests, such as fluorescence in situ hybridisation (FISH) and polymerase chain reaction (PCR), may be performed to detect specific genetic abnormalities associated with follicular lymphoma.
   These tests help in confirming the diagnosis and assessing the prognosis.

How to Prepare for a Doctor’s Consultation?

A doctor consultation is a valuable opportunity to discuss health concerns, seek medical advice, and develop a collaborative action plan with the healthcare provider.

Preparing for this appointment can maximise one's time and ensure a productive and informative discussion. Here are some basic things to prepare: 

1. Individuals should schedule a prior appointment with the doctor.

2. Make a list of medications and supplements that the patient consumes.

3. Make a note of all the symptoms experienced by the patient.

4. Bring relevant medical records during the consultation with the doctor. 

5. Also, make a note of all the relevant doubts and questions. Here are some of the questions that a patient can ask the doctor if diagnosed with follicular lymphoma:

1. What is the stage of the follicular lymphoma?

2. What is the prognosis for follicular lymphoma?

3. What can they do to manage their symptoms?

4. What are the treatment options available for follicular lymphoma?

5. Are there any side effects of the treatment?

6. How can they manage the side effects of treatment?

There are numerous follicular lymphoma therapies available. The specifics of the lymphoma, such as the cell types involved and if the lymphoma is aggressive, will determine the optimal treatment or combination of treatments for the patient. 

The doctor also takes into account the preferences and general health. The patient might not require immediate treatment if the lymphoma seems to be growing slowly and exhibits no symptoms.
The doctor could suggest treatment if the follicular lymphoma is aggressive or produces symptoms. 

To treat follicular lymphoma, medical professionals may combine therapy with watchful waiting. 

1. Watchful Waiting: The patient will be scheduled with routine sessions where the doctor may perform physical exams, laboratory testing, and imaging procedures if watchful waiting is advised.

2. Radiation Therapy: Radiation therapy uses high-energy X-rays or other forms of radiation to target and kill cancer cells. It is typically used in localized areas to treat specific sites affected by follicular lymphoma or to relieve symptoms like pain or swelling.

3. Monoclonal Antibody Therapy: Medical professionals use antibodies generated in laboratories to locate and eradicate specific cancer cells.

4. Chemotherapy: Chemotherapy involves the use of powerful drugs to destroy cancer cells. It is often used as a primary treatment for follicular lymphoma, particularly when the disease is more advanced or symptomatic. 

5. Targeted Therapy: Targeted therapy involves the use of drugs that specifically target certain proteins or genes involved in cancer cell growth.

6. Immunotherapy: Immunotherapy boosts the body's defences. Such treatments can boost the body's creation of cancer-fighting cells or assist healthy cells in recognising and eliminating cancer cells.

7. Bone Marrow/Stem Cell Transplantation: If follicular lymphoma recurs after chemotherapy, medical professionals might suggest this course of action.

Cost of Follicular Lymphoma Treatment

Follicular Lymphoma Survival Rate

The five-year survival rate for follicular lymphoma is relatively high, with estimates ranging from 70% to 90%. This means that, on average, about 70% to 90% of individuals diagnosed with follicular lymphoma are expected to survive for at least five years after their diagnosis.
It's important to remember that these numbers are based on past data and may not reflect the latest advancements in treatment.

The survival rate for follicular lymphoma varies depending on several factors, including the stage of the disease, the patient's overall health, and the specific characteristics of the lymphoma cells.

Follicular lymphoma, like any other cancer, carries certain risks and potential complications. These can vary depending on the stage of the disease, the extent of lymphoma involvement, and individual factors.
It's important to note that not all individuals will experience the same risks and complications.

1. Disease progression: One of the main risks with follicular lymphoma is disease progression. In some cases, the lymphoma may progress to a more aggressive form, such as diffuse large B-cell lymphoma.
   This transformation can lead to more rapid disease progression and may require more intensive treatment.

2. Weakened Immune System: A well-known side effect of follicular  lymphoma treatment is the deterioration of the immune system, which might get worse as they get better.
   A damaged immune system makes an individual more vulnerable to infections and can lead to other significant complications.

3. Infertility: Infertility results from chemotherapy and radiotherapy. This can be permanent, but it can also be transient.
   The patient’s healthcare team will estimate the probability of infertility in the particular situation and discuss the choices with them. 

4. Side Effects of Treatment: The treatment of follicular lymphoma, such as chemotherapy, radiation therapy, or immunotherapy, can have side effects.
   These may include fatigue, hair loss, nausea, decreased blood cell counts, and an increased risk of infections. Close monitoring and supportive care can help manage these side effects.

When to See a Doctor? 

If the patient observes any changes in the  body that could indicate follicular lymphoma symptoms, they  should contact the  doctor as soon as they  can.
The patient’s doctor will plan a series of follow-up appointments to check on their status and/or their treatment if they have been diagnosed with follicular lymphoma.

The patient could ask the doctor if they can participate in a clinical trial. They frequently allow patients to explore novel medications that aren't yet accessible to all. If the patient could be a good candidate for one of these trials, the doctor can let them know.

Although there is no known diet that can treat follicular lymphoma. However, a person's diet may be able to assist them in managing their symptoms and the adverse effects of their treatment.
For those undergoing treatment for blood cancer, the Leukaemia and Lymphoma Society (LLS) offers the following food and nutritional advice:

1. Aim to consume five to ten servings of fruits and vegetables each day, including cruciferous ones like apples, bananas, melons, berries, broccoli, cauliflower, and kale.
   Fruits and vegetables strengthen the patient's immune system. 

   According to studies, patients who consume a lot of green vegetables and citrus fruits like oranges and lemons survive longer than those who don't. 

2. Throughout the day, consume lots of water to avoid dehydration and lessen treatment adverse effects.

3. Electrolyte abnormalities are a relatively frequent side effect for cancer patients.
   They might be linked to a deteriorating outcome, affecting the quality of life, the potential for receiving anticancer medications and affecting survival. 

   To retain electrolytes, such as sodium and potassium, drink broths or sports drinks. This retains the energy levels.

4. Proteins, including some meat, fish, eggs, and pulses, which should make up about a third of a person's daily dietary consumption for energy, along with some milk, other dairy products, or dairy substitutes. 

   This helps in the preservation of a healthy weight, prevention of muscular atrophy, and enhancement of energy levels prior to, during, and following therapy.

Follicular lymphoma is a chronic disorder with a slow rate of growth. The patients may go years without showing any symptoms. However, if they do, they can discover that the cycle between treatment, remission, relapse, and then more treatment, with no apparent end in sight or cure.
However, alternative therapies are being used by researchers in an effort to transfer follicular lymphoma from the list of chronic diseases to the list of diseases that can be cured. Speak with the healthcare practitioner about the patient’s treatment choices if they have follicular lymphoma.

Even though the condition may be fatal, the good news for follicular lymphoma is that many patients may live long lives comparable to healthy people.
Also, according to new research, the majority of patients have a chance for improvement or a cure. As a result, get in touch with HexaHealth to learn about the more recent treatments or clinical trials that might give you a chance to be cancer-free.

Suggested Reads