Follicular lymphoma is a very slow-progressing type of cancer that hampers the lymphatic system of the body. This is the system that is responsible for immunity building and protecting the body from infections and diseases. It accounts for 30% of non-Hodgkin’s B-cell lymphoma cases. Research is constantly being done to understand different types of cancer, including follicular lymphoma. To improve patient care, new and advanced treatments are being introduced every year. For example, inhalable exosomes are a modern potential treatment for lung cancer.
What does it feel like?
In many cases, follicular lymphoma is silent, asymptomatic, and indolent. However, it is essential to diagnose it timely to get the treatment onboard. In cases where the condition is symptomless, it can still be identified by the presence of lumps. These lumps result from swollen lymph nodes and are mostly painless. Other symptoms of follicular lymphoma are as follows:
- Chills and inundating sweats during the night
- More than 10% weight loss in a short duration, with no obvious reason
- Fever that does not result from other medical conditions such as viral infections
- A continuous sense of fatigue that makes it difficult to handle daily tasks efficiently
How does it progress?
It is named follicular lymphoma because the white blood cells combine to form a cluster or follicle in the lymph nodes. Afterwards, they may travel and form tumors in the bone marrow, or other lymphatic organs.
Further investigation into the causes and triggers of this atypical cell growth remains necessary. Potential risk factors may encompass exposure to certain chemicals, genetic mutations, medications that compromise the immune system, male gender, and advancing age. Approximately 85% incidents of this condition are caused by genetic changes that trigger abnormal cell multiplication.
The progression of follicular lymphoma is mostly sedate, but it can accelerate rapidly in some cases. This happens when it:
- Transforms
3% of follicular lymphoma patients can transition into diffuse large B-cell lymphoma (DLBCL), a more aggressive type of cancer. Consequently, they develop extreme symptoms and may travel faster in other parts of the body.
- Relapses
Sometimes, the symptoms of follicular lymphoma can return after a treatment that was initially successful. When these patterns of remission and relapse are continuous, patients often feel they can never truly declare their treatment as complete.
Different variants of follicular lymphoma
Generally, it affects everyone in the same way. However, it can sometimes take form of a rare variant, such as:
Duodenal follicular lymphoma
Duodenal follicular lymphoma is a form of cancer that develops in the small intestine, also known as the small bowel or gut. This type of lymphoma tends to grow slowly and is often identified at an early stage. It is generally not associated with metastasis to other areas of the body, nor does it typically transform into a more aggressive form of lymphoma.
Pediatric follicular lymphoma
It is a type of follicular lymphoma that originates in children but can sometimes also affect adults. Pediatric lymphoma is more common in men as compared to women. During this condition, lymph nodes around the head and neck get swollen. It is generally identified in its initial stages and is often successfully treated.
Stages of follicular lymphoma
Since different stages of the disease require different modes of treatment, healthcare professionals find it suitable to track them. Following are the stages of follicular lymphoma, each requiring a unique treatment module:
Stage I
This is when lymphomas are found in one or two lymph nodes. At this stage, 25% out of all cases are detected.
Stage II
This stage symbolizes lymphomas in the upper and lower regions of the diaphragm. 15% follicular lymphomas can be diagnosed during this stage.
Stage III
26% of the cases are identified in this phase. This is when lymphomas surround the sides of one’s diaphragm.
Stage IV
This stage occurs when cancer has extended beyond the lymph nodes to involve the bone marrow and/or other organ systems. Healthcare professionals identify approximately 27% of all cases of follicular lymphoma at this point.
Diagnosis: Imaging and testing
Healthcare professionals may employ a variety of tests to confirm the presence of follicular lymphoma:
- Positron emission tomography (PET) scans: This imaging technique allows healthcare professionals to assess the activity of cancer cells and determine the grade of the cancer.
- Computed tomography (CT) scan: This examination assists healthcare providers in tracking the progression of cancer and assessing the effectiveness of treatment.
- Biopsy: Medical practitioners may extract tissue samples from lymph nodes to check for indications of cancer.
Treating the condition
- Traditional treatments
The traditional, on-going treatments include active surveillance for early, mild, and asymptomatic cases of follicular lymphoma. Here, the goal is to track how the disease is progressing. Other invasive treatment options include chemotherapy, targeted therapy, monoclonal antibody therapy, immunotherapy, radiation therapy, and stem-cell transplantation.
- Modern research on treatments
Apart from the traditional treatments that are readily available, new research is paving from improved and efficient treatments for the conditions. Examples include:
- New drugs
These include drugs that inhibit proteins responsible for DNA changes that trigger production of lymphomas.
- Antibody-drug conjugates
Antibodies are attached to chemotherapy agents, allowing them to bind to a specific protein found on the surface of lymphoma cells. This mechanism enables the targeted delivery of the chemotherapy drug directly to the affected cells.
- New antibody therapies
Also known as bispecific antibodies, these perform a dual function by binding to two consecutive bodies at one time. These involve the lymphoma cells and the T-cells. When the antibodies are attached to both simultaneously, it helps the T-cells identify and destroy the affected cells easily.
- CAR-T cell therapy
This process entails the genetic modification of the body’s own T cells, enabling them to identify and eliminate lymphoma cells effectively.
- Cell signal blockers
B-cell communication through specific signals that promote their division or survival is hindered during this process. Among the agents that inhibit these cellular signals are targeted therapies like BTK inhibitors, PI3K inhibitors, and BCL-2 inhibitors, each named for the specific proteins they obstruct.
Read Also: What are Solid Tumor Clinical Trials and Why Are They Important?
Bottom line
Follicular lymphoma is the most prevalent type of non-Hodgkin’s lymphoma, that escalates the formation of tumors in the lymphatic system. Continuous research is being done to improve the modes of treatment and enhance patient satisfaction. Nebraska Hematology Oncology Clinical Research is one example of bodies that are conducting safe and effective clinical trials.