The most common type of blood cancer is lymphoma, which is developed by a defect in white blood cells lymphocytes, and can be classified as Hodgkin’s or non-Hodgkin’s lymphoma, according to its characteristics. The lymphocytes multiply and enlarge abnormally, rather than dying naturally and leaving space for new cells.
Follicular lymphoma is a non-Hodgkin’s type of lymphoma, originating in the B lymphocytes, or B-cells, and it is the most common form of slow-growing disease.
About 20 percent of all non-Hodgkin’s lymphomas are follicular lymphomas, which can develop in any part of the body, causing symptoms like swollen lymph nodes. The average age for people who develop the disease is 60, according to the American Cancer Society.
Patients who suffer from the disease don’t usually experience strong or obvious symptoms for a long time before diagnosis due to the indolent nature of this lymphoma. The progression of the disease depends on many factors, but it is usually not a threat to patients’ lives until it is in an advanced stage, which can take years.
Follicular Lymphoma Development and Risk Factors
Follicular lymphoma gains its name due to its appearance. The disease affects mostly the lymph nodes, like other lymphomas, and under the microscope, it shows rounded structures resembling follicles. Nearly all patients who suffer from it have a mutation in the BCL-2 gene and translocation between the 14 and 18 chromosomes — alterations that result in abnormally high production of the BCL2 protein, which is responsible for the apoptosis or the natural life and death cycle of the cells.
The reasons for these mutations are not fully understood, but it is known that the disease affects men and women equally, although older patients are more likely to suffer from follicular lymphoma. Asians and people from Africa are less likely to develop it.
Follicular Lymphoma Symptoms and Diagnosis
The most common signs of a lymphoma start with painless swellings in the lymph nodes, particularly in the neck and armpits. Night sweats, fever, unexplained weight loss, fatigue, and other symptoms can also occur, mostly in advanced stages. Patients with follicular lymphoma are at particular risk of developing abdominal tumors that can obstruct normal digestion and urination. Because follicular lymphoma progresses slowly, the symptoms can go unnoticed for years.
As a silent cancer with subtle symptoms, the diagnosis is more difficult and it is often done in later stages of the disease. When a physician suspects a patient suffers from lymphoma, the first step is to conduct a complete physical exam and ask for a medical history. The most common diagnosis method is a biopsy, but other tests may be needed to evaluate the type, extent, and stage of the disease, including complete blood count (CBC), blood smear or manual differential, blood chemistry, and additional imaging tests.
Treatment and Prognosis of Follicular Lymphoma
Treating follicular lymphoma differs according to the stage of the disease, among other factors. Since it grows so slowly, watchful waiting may be recommended in early stages. Radiation and chemotherapy are the most common options to treat the disease, which help manage the lymphoma more than cure it. Most cases of follicular lymphoma are incurable, but the average survival in advanced stages of follicular lymphoma is about 20 years.
The study “Follicular lymphoma — treatment and prognostic factors,” published in 2012, revealed that the results of treating follicular lymphoma improved drastically in recent years “due to the use of very effective immunochemotherapy regimens.” Researchers also believe that improvements in the field will continue to be made, leading to new and more effective monoclonal antibodies, the identification of safer chemotherapy regimens, and new maintenance therapies.
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