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This information is about a specific type of non-Hodgkin lymphoma (NHL), known as follicular lymphoma. It should ideally be read with our general information about non-Hodgkin lymphoma.
Follicular lymphoma is a common type, accounting for about 1 in 4 of all cases. It is a cancer of the B-lymphocytes. Follicular lymphoma can occur any time during adulthood, the average age being in the 60s. It is equally common in men and women.
The causes of follicular lymphoma are unknown. Follicular lymphoma, like other cancers, is not infectious and cannot be passed on to other people.
The first sign of the condition is often a painless swelling in the neck, armpit or groin, caused by enlarged lymph nodes. Sometimes more than one group of nodes are affected. The lymphoma may spread to involve various organs in the body, such as the bone marrow, liver, lungs or skin. Some people experience a loss of appetite and tiredness.
Other symptoms may include night sweats, unexplained high temperatures, and weight loss. These are known as B symptoms.
A diagnosis is made by removing an enlarged lymph node, or part of it, and examining the cells under a microscope (biopsy). It is a very small operation and may be done under local or general anaesthetic. Biopsies may also be taken from other body tissues.
Additional tests, including blood tests, x-rays, scans, and bone marrow samples, are then used to get more information about the type of lymphoma and how far it has spread in the body. This information is used to help decide which treatment is most appropriate for you.
The stage of non-Hodgkin lymphoma describes how many groups of lymph nodes are affected, where they are in the body, and whether other organs such as the bone marrow or liver are involved.
The stage usually includes the letter A or B, which describes whether or not any B symptoms are present (eg stage 2B). Sometimes the lymphoma can start in areas outside the lymph nodes, and this is represented by the letter E, which stands for extranodal (eg stage 3AE).
Non-Hodgkin lymphomas are also divided into one of two groups: low- and high-grade. Low-grade lymphomas are usually slow-growing, and high-grade lymphomas tend to grow more quickly.
Follicular lymphoma is a low-grade lymphoma and usually develops very slowly.
If the lymphoma is causing no symptoms, it may not be necessary to give treatment immediately. You will be seen regularly by your cancer specialist or GP, and treatment will be advised when you start to get symptoms. It may be some time before this happens, and some patients may never need any treatment.
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It may be given if the lymphoma has spread to several groups of lymph nodes and/or other organs. Follicular lymphoma is very sensitive to chemotherapy and often disappears with this treatment.
Chemotherapy is frequently given in the form of tablets, using a drug called chlorambucil, which may be combined with steroids. A drug called fludarabine, which is injected into a vein, may also be used; either alone or in combination with other drugs.
A commonly used regimen of chemotherapy drugs for follicular lymphoma is R-CVP. This includes the monoclonal antibody rituximab (Mabthera®), the chemotherapy drugs cyclophosphamide and vincristine, and the steroid prednisolone.
Although follicular lymphoma usually responds well to chemotherapy, there is a risk that it may come back in future years. However, further chemotherapy can then be given and control the lymphoma again. This pattern may repeat itself over many years.
In some people, follicular lymphoma may become resistant to chemotherapy and in others it may change (transform) into a high-grade non-Hodgkin lymphoma, usually a type known as diffuse large B-cell.
Steroids are drugs which are often given with chemotherapy to help treat lymphomas. They also help you feel better and can reduce feelings of sickness.
Monoclonal antibodies are drugs that recognise, target, and stick to specific proteins on the surface of cancer cells, and can stimulate the body’s immune system to destroy these cells.
Rituximab (Mabthera®) is a monoclonal antibody which is commonly used to treat follicular lymphoma. It is usually given with chemotherapy as part of a regime called R-CVP (see above).
Maintenance therapy Some people who have no signs of lymphoma at the end of their treatment (remission) may be given additional treatment to help keep the lymphoma away. This involves treatment with rituximab every three months for up to two years.
More types of monoclonal antibodies are being researched. Some are attached to low doses of radioactivity to see whether this will make them more effective in treating the lymphoma. The most commonly used radioactive monoclonal antibodies are 90Y-ibritumomab tiuxetan (Zevalin®) and Iodine131 tositumomab (Bexxar®).
High-dose chemotherapy with bone marrow or stem cell infusions has been used for some patients. This type of treatment involves very intensive chemotherapy.
As the side effects can be severe, some types of high-dose treatment are not given to people over the age of 45–50, while others can be given to people of up to 65 who are fit enough to have it. The intensity of the treatment increases the risks of serious side effects for people over these ages.
Radiotherapy is the use of high-energy rays to destroy cancer cells, while causing as little harm as possible to the healthy cells. It may be used when the lymphoma cells are contained in one or two groups of lymph nodes in the same part of the body (Stage 1 or 2). Treatment of early-stage follicular lymphoma may lead to a cure in some people. Radiotherapy may also be given with chemotherapy.
New treatments for follicular lymphoma are being researched all the time, and you might be invited by your doctor to take part in a clinical trial to compare a new treatment against the best available standard treatment. Your doctor must discuss the treatment with you, and have your informed consent before entering you into any clinical trial.
The need for practical and emotional support will of course be individual. For some people with follicular lymphoma, life may seem largely unaffected; for others the diagnosis of cancer may be a cause of great fear and distress. If you would like to discuss the condition, its treatment, or the practical and emotional problems of living with follicular lymphoma, please contact our cancer support service.
This section has been compiled using information from a number of reliable sources, including:
For further references, please see the general bibliography.
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