Follicular Lymphoma: Can It Be Missed?

Diagnosing cancer early can help to improve patient outcomes and quality of life; however, some cancers may be difficult to detect in early stages as they may have few or no symptoms or symptoms similar to less serious illnesses. This is true of some types of lymphoma, and patients with lymphoma are more likely to have multiple primary care appointments before being referred to a specialist. Studies have indicated that two out of five patients with lymphoma are diagnosed when they seek emergency medical care, which is associated with more advanced-stage disease. 

Can You Have Follicular Lymphoma Without Knowing?

Follicular lymphoma is a type of non-Hodgkin lymphoma. It is indolent, meaning it grows and spreads slowly, and this can contribute to a delayed diagnosis. Some patients might not have any symptoms for many years. 

Patients with follicular lymphoma might also experience swollen lymph nodes, however, the size may change several times before they seek medical attention. When symptoms do arise, such as fever, night sweats, weight loss, pain, and fatigue, they can be misinterpreted as other conditions. Patients may notice the emergence of non-specific symptoms or have a general sense of feeling unwell. During evaluation, these symptoms can be attributed to everyday illnesses or non-physical, lifestyle, and age-related factors. 

Some patients may develop large abdominal tumors that could disrupt the digestive, urinary, or blood vessel systems without causing symptoms.

How is Asymptomatic Follicular Lymphoma Treated?

Follicular lymphoma can progress slowly over many years, and immediate treatment may not be needed if the patient is asymptomatic. Healthcare professionals may adopt a "watch and wait" approach for these patients, as immediate treatment may not be beneficial. Instead, the patients are closely monitored through frequent visits and blood work testing to detect any signs of disease progression.

As soon as symptoms are identified, patients start treatment. Usually, doctors will recommend a less toxic treatment than standard chemotherapy, such as rituximab or radioimmunotherapy. 

Key takeaways

• Patients with follicular lymphoma might not have any symptoms for many years.
• Some symptoms of follicular lymphoma can be misinterpreted as less serious conditions.
• Patients with asymptomatic lymphoma are typically closely monitored for any signs or symptoms of progression and may not need treatment right away. 

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Sources: 

• Disease-related factors affecting timely lymphoma diagnosis: a qualitative study exploring patient experiences
• Patient education: Follicular lymphoma in adults (Beyond the Basics)
• The asymptomatic follicular lymphoma (AFL) trial: single-agent rituximab immunotherapy versus 90Y-ibritumomab tiuxetan radioimmunotherapy (RIT) for patients with new, untreated follicular lymphoma