Follicular lymphoma is the second most common type of non-Hodgkin’s lymphoma. Many patients respond well to treatment and live with the condition as a chronic disease. Because there are different treatment approaches, patients have much hope and promise in managing their disease.

Factors for determining treatment

After you are diagnosed with follicular lymphoma, your doctor will run blood tests, bone marrow tests, and CT scans. The results will help determine the stage of your cancer and if you need treatment. Follicular lymphoma has four stages. It is slow growing, which means the disease can spread to other areas of the body before it is diagnosed. As a result, many patients are diagnosed at stage III or stage IV.

While the stage of your cancer is important, it is not the only piece of information that will help your doctor determine your treatment. He or she will examine several factors, including your age, the number of lymph nodes that are affected, and your blood test results.

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If you have symptoms such as fever, chills, weight loss, low blood count, or a mass of enlarged lymph nodes in various sites, your doctor may start you on rituximab (Rituxan).

Not every patient with follicular lymphoma needs treatment. If you don’t have any symptoms and your blood count is within normal range, your doctor may suggest observing the disease until it starts to affect your quality of life. This is often referred to as “watch and wait.” Some patients with follicular lymphoma can live for years without being on therapy. Talk to your doctor about choosing an approach that is tailored to your age and your health.

Treatment approaches

If you do need treatment, your doctor may first put you on rituximab with chemotherapy. Rituximab is tolerated well by patients and can be combined with many types of chemotherapy or given alone.

If rituximab does not keep your symptoms under control, your doctor may try other options including radiation therapy, chemotherapy drugs, and radio-labeled monoclonal antibodies, such as ibritumomab tiuxetan (Zevalin) or tositumomab (Bexxar).

There are a variety of treatments that are effective for patients living with follicular lymphoma. Talk with your health care provider to find the best combination approach for you.

Managing side effects

Maintaining a good quality of life remains the main concern for follicular lymphoma patients. Before deciding on a treatment, patients should have a discussion with their health care team about how therapy might impact their quality of life. Ask about side effects before starting a therapy and how to manage them. If you are younger, you may want to bring up concerns about fertility. Don’t be afraid to ask your doctor how treatment may impact your sexual health.

A common side effect for patients is peripheral neuropathy, which includes numbness, pain, and tingling in your hands and feet. This side effect can be managed when discussed with your health care team early on in treatment. Slight changes in the doses of drugs or schedule of drugs can make a vast difference without impacting treatment response.

If you are experiencing nausea, talk with your doctor or nurse about drugs that can help minimize this side effect. If you develop a fever, tell your doctor right away because it may be a sign of an infection.

In order to help manage side effects, it is important to talk to your health care team if you notice any changes to your quality of life. Work with them to find the right combination of drugs that work for you. By communicating with your health care providers, you can work together to best manage your follicular lymphoma.