What Are Early Signs of Follicular Lymphoma?

Follicular lymphoma is a type of non-Hodgkin lymphoma (NHL). It is indolent, meaning it grows and spreads slowly, which can lead to a delayed diagnosis. Some patients might not have symptoms for many years, or the symptoms can be easily missed. When noticeable symptoms arise, they are similar to those of other lymphoma types. 

Because follicular lymphoma can stay undetectable in the body for some time, it's important to know what to watch for so that you can work with your doctor immediately if you notice any signs or symptoms of this cancer. 

What Are the Symptoms of Follicular Lymphoma? 

Swollen Lymph Nodes/Lymphoma Lumps 

Swollen lymph nodes are a common symptom of lymphoma. Lymph nodes are considered enlarged if they exceed 1.5cm in diameter. They can appear as visible lumps under the skin, typically affecting the neck, armpit, and groin areas. 

While lymphoma lumps often appear in clusters, it is also possible to have a single lump. Other benign skin lumps, such as cysts and lipomas, can be harmless and are not necessarily a cause for concern. 

Lymphoma lumps typically feel rubbery and are usually painless. Lymph nodes may also swell when the body is fighting an infection. Lymph nodes that become noticeably enlarged without an apparent infection should be checked by a physician, as this may be a warning sign of lymphoma. 

In patients with follicular lymphoma and other low-grade lymphomas, the size of lymph nodes may fluctuate over time, often increasing and decreasing in size. 

Frequent Infections and Abnormal Fatigue

Lymphoma (including follicular lymphoma) is a type of cancer that forms in the lymphatic system. Lymphocytes, a type of white blood cell, undergo abnormal changes and grow uncontrollably. 

These abnormal cells do not function properly, which can weaken the immune system. As these cells build up in the bone marrow, they can reduce the number of healthy cells, making patients with follicular lymphoma more susceptible to infections. 

These infections can be more severe and longer lasting. The energy spent fueling the rapid growth of lymphoma can also affect patients, so any abnormal amounts of fatigue should also be reported to your physician. 

Other Lymphoma Symptoms 

Apart from swollen lymph nodes, the following signs or symptoms should be brought up to your doctor as they may indicate follicular lymphoma: 

• Night Sweats 
• Fever (that cannot be attributed to an infection) 
• Fatigue 
• Unexplained weight loss 
• Skin rash or itchy skin 
• Pain in the chest, abdomen, or bones 

How Is Follicular Lymphoma Diagnosed? 

Blood count tests and blood chemistry analyses may detect signs of lymphoma. However, blood work alone is insufficient to diagnose lymphoma. A biopsy is necessary to diagnose lymphoma, as it involves removing all or part of an enlarged lymph node and examining the cells. This alone will confirm the diagnosis of lymphoma (including follicular lymphoma).  

What Are the Stages of Follicular Lymphoma? 

Once a diagnosis is confirmed, tests are performed to determine how much the disease has spread, a process known as staging.

Along with a medical history and physical examination, several tests, including blood tests and CT/PET scans, are used to determine the stage. 

The stages of lymphoma are:

• Stage I: Only one lymph node region or structure is involved
• Stage II: Two or more lymph node regions or structures on the same side of the diaphragm are involved
• Stage III: Lymph node regions or structures on both sides of the diaphragm are involved
• Stage IV: Widespread involvement of several organs or tissues other than lymph nodes or structures. 

Key Takeaways

While patients with follicular lymphoma may not have symptoms or signs for many years, it's vital that you are aware of these early signs and symptoms. Knowing these symptoms can help you work immediately with your doctor to get an early diagnosis, hopefully catching the follicular lymphoma at an earlier stage. 

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Sources:

• HealthTree for Follicular Lymphoma 101 pages
• What Does Lymphoma Feel Like
• Patient education: Follicular lymphoma in adults (Beyond the Basics)
• Non-Hodgkin Lymphoma Treatment (PDQ®)–Patient Version