Follicular Lymphoma: Information on Causes, Diagnosis & Treatments

Follicular Lymphoma Overview

Non Genetic Non Hodgkin Lymphoma Follicular lymphoma is a form of non-Hodgkin lymphoma cancer that affects the bodies B-lymphocytes, which are white blood cells that attack and destroy infections. The abnormal white blood cells can spread throughout the body into organs, lymph nodes, bone marrow, and other tissue. Typically, tumors will form in these locations.

Scientists and research which have yet to develop a cure for follicular lymphoma. However, many individuals with the condition live a long and active life. Unlike many cancers, follicular lymphoma is not inherited or passed down through families from one generation to another. However, elderly individuals 60 years and older are more likely to develop the condition compared to younger males and females.

Scientists named this form of non-Hodgkin disease by its appearance under the microscope where the cellular structures resemble hair follicles. However, it is caused by a BCL-2 Gene mutation that occurs between the chromosome 14 and chromosome 18 that produces an abnormally elevated level of BCL2 protein that causes apoptosis which is the normal natural lifecycle of the cell to mature, reproduce, and then kill itself.

What Causes Follicular Lymphoma?

On average, individuals 50 years and older acquire follicular lymphoma compared to those at a younger age. Although scientists know there are genetic mutations of the chromosomes and jeans associated with follicular lymphoma, identifying the changes as the actual cause has not yet been determined. Follicular lymphoma is not contagious and cannot be passed on to other individuals.

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Who is at Risk for Follicular Lymphoma?

According to the CDC (Centers for Disease Control and Prevention), more than 72,000 cases involving forms of non-Hodgkin lymphoma were diagnosed in the United States in 2016. Twenty percent of all these cases involved follicular lymphoma. Both males and females seem to be equally at risk of developing the disease, as are most ethnic groups except African-Americans and Asian-Americans.

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Common Symptoms

Individuals who suffer from follicular lymphoma usually never experienced symptoms that are strong enough are obvious enough to be detected by a doctor. Because of its indolent nature, follicular lymphoma is difficult to diagnose. As the disease progresses, it often does not cause significant harmful symptoms until it reaches an advanced stage which often takes many years.

Most of the detectable symptoms are associated with dysfunctional bone marrow that causes anemia (low red blood cell count), leukopenia (low white blood cell count), or thrombocytopenia (low platelet cell count).

Common detectable follicular lymphoma symptoms include:

  • Fatigue

  • Unexpected weight loss

  • Night sweats

  • Shortness of breath

  • Pain was swelling of lymph nodes in the armpit, stomach, groin or neck area

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Diagnosing and Staging Follicular Lymphoma

To ensure an accurate diagnosis the condition, the doctor will perform a comprehensive physical evaluation and examine the reticuloendothelial (immune-response monocytes and macrophages) system in lymph node areas that present abnormal characteristics.

Because many of the symptoms associated with the disease can come and go, the doctor will ask numerous questions to help in their diagnosis including:

  • Have you ever detected a lump in your stomach, groin, neck or armpits? When they appeared, were they painful? If the lump disappeared, did it ever reappear?

  • Has any other doctor diagnosed you with cancer and did you receive treatment?

  • Do you know if you have ever been exposed to any chemicals that cause cancer in your work, home, or social environment?

  • Has any doctor ever diagnosed you with rheumatoid arthritis, celiac disease, lupus, or HIV?

  • Are you the recipient of an organ transplant?

The doctor will also examine the spleen, liver, and throat and perform other diagnostic tests and evaluations including:

  • Complete Blood Cell Count (CVC) – This test can differentiate normal from abnormal blood cells to assist in the diagnosis of verifying follicular lymphoma.

  • CT (Computed Tomography) Scan – Obtaining an imaging scan of the pelvis, abdomen, and chest areas can identify pelvic or abdominal adenopathy (enlarged lymph glands) if present. The doctor might also recommend a PET (positron emission tomography) scan that can identify localized diseases.

  • Tissue Biopsy – Obtaining a biopsy is crucial for establishing the diagnosis of follicular lymphoma. This can help determine if the disease is extranodal or residing outside the lymphatic system into other areas of the body including organs.

  • Bone Marrow Aspiration and Chromosomal Analysis – This procedure removes a small portion of bone marrow through aspiration by a long fine needle usually inserted in the back of the hipbone to detect abnormalities in the patient’s chromosome makeup associated with follicular lymphoma.

Staging the Disease

Once the disease has been diagnosed by competent doctors and pathologists, the cancerous condition needs to be staged to ensure the patient is receiving the most appropriate and effective treatment. Staging involves:

  • Stage I – At this stage, the disease is located in a single lymph node or in a single lymph node area.

  • Stage II – Once the disease progresses, it involves two or more lymph node or areas that form on one side of the diaphragm.

  • Stage III – In the beginning advancing stages, the condition has migrated to more than one lymph node or area on both sides of the diaphragm.

  • Stage IV – At the most advanced stage, the disease has disseminated (widely spread) and now involves the central nervous system, liver, or bone marrow.

In addition to staging the disease, scientists will grade the disease based on the number of centroblasts. The higher number of centroblasts in the test sample, the higher the grade.

  • Grade 1 – This grade presents 0-5 centroblasts per high-power field

  • Grade 2 – This grade presents 6-15 centroblasts per high-powered field

  • Grade 3 – This grade represents more than 15 centroblasts per high-powered field.

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Treating the Condition

The type of treatment the doctor will recommend will differ greatly based on the progression of cancer along with other factors. If the follicular lymphoma is progressing slowly, the doctor may choose to a “watchful waiting” approach to see if the condition becomes worse over time. Treatment might not be started until the lymph nodes become larger in size or the patient develops night sweats or fevers, has unexpected weight-loss, or their test results show low blood counts.

However, other treatments could include chemotherapy and radiation treatments as an effective way to manage the disease more than cure it. This is because most forms of the disease cannot be cured. That said, the average survival rate of a patient with follicular lymphoma in its advanced stage is approximately twenty years. To ensure a longer lifespan, the doctor may recommend:

  • Radiation Treatments that destroy cancer cells using X-ray energy beams to focus on the affected areas in the body. Radiation has been proven effective at destroying follicular lymphoma, especially in its early stage.

  • Monoclonal Antibodies can be an effective treatment because the antibodies act much like the body’s normal disease-fighting cells. Rituxan (rituximab) has been shown to be highly effective at destroying lymphoma cells while preventing damage to normal healthy tissue. In addition, this form of treatment produces far fewer side effects compared to other options including chemotherapy.

In addition, there are clinical trials available for individuals with advanced stages of follicular lymphoma. However, participating in a clinical trial in no way guarantees a successful outcome.

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Sources:

https://connect.mayoclinic.org/discussion/follicular-lymphoma-symptoms/

https://www.cancer.org/cancer/non-hodgkin-lymphoma/detection-diagnosis-staging/factors-prognosis.html

http://www.clevelandclinicmeded.com/live/courses/ann/IRIM/2012/osyllabus/7/1100-Pohlman-Lymphoma.pdf

https://www.cancer.gov/types/lymphoma

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