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FAQ for Follicular Lymphoma

What is Lymphoma ?

Lymphoma is a cancer of lymphocytes, a type of white blood cell. Lymphocytes circulate in the body through a network referred to as the lymphatic system, which includes the bone marrow, spleen, thymus, and lymph nodes. There are two main types of lymphoma:

Hodgkin's lymphoma (also called Hodgkin lymphoma)

Non-Hodgkin's lymphoma (NHL).

NHL is the most common type of lymphoma. Follicular lymphoma is one form of NHL. In contrast to some of the other forms of NHL, follicular lymphoma usually grows slowly and thus may not require treatment for many years. Because of its slow growth characteristics, follicular lymphoma is referred to as being an indolent (rather than aggressive or highly aggressive) lymphoma.

What causes Follicular Lymphoma ?

Age, gender, and race/ethnicity affect a person's likelihood of developing follicular lymphoma, although most persons have no known risk factors. Follicular lymphoma is slightly more likely to be diagnosed in women than men. Nearly all persons diagnosed with follicular lymphoma are adults, with the average age at diagnosis being 60 years.

What are its symptoms ?

The initial symptoms of follicular lymphoma include painless swelling in one or more of the body's lymph nodes, particularly in the neck, armpit, or groin areas. Often, patients with follicular lymphoma complain that their lymph nodes have been swollen for a long time; the size may increase and decrease several times before the patient seeks medical attention.In the early stages, only one or two lymph nodes may be involved with the lymphoma. However, staging studies typically show that follicular lymphoma affects lymph node sites throughout the body.

How is it diagnosed ?

The diagnosis of follicular lymphoma is confirmed by removing all or part of an enlarged lymph node to examine its cells under a microscope, a procedure known as a biopsy. Additional diagnostic tests are used to obtain more information about the type of lymphoma and the extent to which the disease has spread in the body. This process is called staging. The results of these tests will help determine the most effective course of treatment.

Diagnostic tests

A number of diagnostic tests are available to help determine which areas of the body have been affected. Tests that may be done include:

CT scan of the chest, abdomen, and pelvis

Blood tests

Bone marrow biopsy: Removal of tissue from the bone marrow, the spongy area in the middle of large bones, for analysis.

PET scan: This test uses a small amount of a radioactive substance, which is injected into a vein; the radioactive substance is absorbed by the cancer cells and can be viewed with a special camera.

What is staging of Lymphoma ?

Staging involves dividing patients into groups (stages) based upon how much of the lymphatic system is involved at the time of diagnosis. Staging helps determine a person's prognosis and whether treatment is required.

It is divided into 4 stages. Stage 1 being the earliest and stage 4 involving many lymphnode areas or bone marrow.

It is also graded into 3 types depending on the examination of the lymphnode under the microscope.

What is the treatment ?

Follicular lymphoma is a slow growing tumour and the slow-growth characteristics make the tumours relatively less responsive to standard forms of cancer treatment (compared to the more aggressive lymphomas).

Early stage disease:

Patients with early stage disease (stage I or II) who develop symptoms may be treated with radiation therapy alone.

Radiation therapy:

Radiation therapy uses high-energy beams (gamma rays) to slow or stop the growth of cancer cells, and is administered to the region of affected lymph nodes (called involved field radiation) or to the affected and surrounding lymph nodes (called extended field radiation). Radiation therapy must be given in small daily doses over a period of weeks to minimize the side effects; the number of weeks depends upon the amount of radiation to be administered.

Advanced stage disease:

Advanced stage disease includes persons with stage II, III and IV disease. There are many treatment options for patients with advanced stage disease. The choice of treatment depends upon the patient's preference and the need for the treatment to act quickly. Most advanced stage disease is treated with either a single chemotherapy drug or combination of chemotherapy drugs.

Chemotherapy:

Chemotherapy refers to the use of medicines to stop or slow the growth of cancer cells. A chemotherapy drug or combination of drugs is referred to as a regimen. Regimens used for the treatment of follicular lymphoma may include a single agent taken by mouth on a daily basis, while other regimens are given intravenously (through a vein) in treatment cycles. A cycle of chemotherapy refers to the time it takes to give the drugs and the time required for the body to recover.

Monoclonal antibody treatment:

A monoclonal antibody is a purified protein that targets a specific group of cells (usually cancer cells). This has advantages over other cancer treatments such as chemotherapy, which targets all rapidly growing cells. There are usually fewer side effects and long-term risks of monoclonal antibody therapies as compared to traditional chemotherapy.
Rituximab is a monoclonal antibody treatment that may be used for patients with follicular lymphoma who have relapsed or not responded to other treatments. Rituximab is frequently combined with chemotherapy treatments, and is being tested as a long-term maintenance treatment after chemotherapy.

Radioimmunotherapy:

Radioimmunotherapy (RIT) uses radioactive isotopes that are linked to monoclonal antibodies. As a result, radiation therapy can be delivered directly to proteins on cancer cells, which reduces the exposure of healthy tissues to radiation. The cost of RIT is quite high, and there are potentially serious short and long-term side effects of the treatment.

Bone marrow transplantation

Hematopoietic cell (bone marrow) transplantation is generally reserved for patients whose lymphoma has recurred after treatment.

What is the prognosis (outcome) ?

It will be discussed with you in detail and differs for each patient.

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