Follicular Lymphoma Stage II
Follicular lymphoma stage II is an early form of slow-growing blood cancer affecting lymph nodes on the same side of the diaphragm, with treatment options that may lead to long-term remission.
Table of contents
- What is follicular lymphoma stage II?
- Symptoms
- How doctors diagnose this condition
- Treatment options
- Outlook
What is follicular lymphoma stage II?
Follicular lymphoma is a type of non-Hodgkin lymphoma (NHL), which is cancer that affects the lymphatic system. The lymphatic system is an important part of the immune system, with tubes called lymph vessels that carry a liquid called lymph throughout the body. This liquid contains white blood cells called lymphocytes that help fight infections.[1][2]
Follicular lymphoma is the second most common type of NHL and accounts for about 30% of all lymphomas. It is generally a slow-growing (indolent) cancer that develops from B lymphocytes, which are white blood cells that make antibodies to fight infections. The cancer is called “follicular” because the abnormal B cells usually develop in clumps called “follicles” inside lymph nodes.[1][2]
Stage II follicular lymphoma means the cancer is found in two or more groups of lymph nodes, but they are all on the same side of the diaphragm. The diaphragm is a band of muscle that separates the chest from the abdomen. This stage is considered early-stage disease.[1][8]
Symptoms
Some people with follicular lymphoma stage II may not have any symptoms at all. When symptoms do occur, the most common one is painless swelling in the neck, armpit, or groin. This swelling is caused by enlarged lymph nodes.[1][4]
Other symptoms may include feeling very tired (fatigue), fever, heavy sweating at night, chills, and unexplained weight loss, especially losing 10% or more of body weight within the past six months. Doctors call this group of symptoms “B symptoms.”[1][4]
How doctors diagnose this condition
The only way to know for sure if someone has follicular lymphoma is through a biopsy. A biopsy is a procedure where a doctor removes all or part of a swollen lymph node. The tissue is sent to a laboratory where a specialist looks at it under a microscope.[1][4]
After confirming the diagnosis, doctors will order tests to determine the stage of the cancer. These tests help show how far the disease has spread. Tests may include blood tests, PET scans (positron emission tomography scans), CT scans (computed tomography scans), and a bone marrow test. In a bone marrow test, a needle is used to take a sample from the hip bone to check if cancer cells are present in the bone marrow, where blood cells are made.[1][6]
Doctors may also perform blood tests to measure levels of lactate dehydrogenase (LDH), which may be higher if the lymphoma is changing to a more aggressive type.[6]
Treatment options
For stage II follicular lymphoma, treatment depends on the size of the tumors and whether symptoms are present. If tumors are small and there are no symptoms, doctors may suggest watchful waiting, also called active surveillance. With this approach, the doctor watches the cancer closely with regular checkups, but treatment is delayed until symptoms develop.[10][13]
When treatment is needed for stage II follicular lymphoma with small tumors, radiation therapy is often the main treatment. Radiation uses high-energy rays to kill cancer cells. In about half of people, radiation therapy can send the cancer into long-term remission, and it may even cure the lymphoma in some cases.[1][10]
For stage II follicular lymphoma with larger tumors (called bulky tumors), treatment usually involves a monoclonal antibody such as rituximab (Rituxan) or obinutuzumab (Gazyva), often combined with chemotherapy. Monoclonal antibodies are drugs that target specific markers on cancer cells. After this treatment, radiation therapy may also be given, depending on which lymph nodes are affected.[10][13]
Common chemotherapy combinations used include R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone), R-CVP (rituximab, cyclophosphamide, vincristine, and prednisone), or R-Bendamustine (rituximab and bendamustine).[10][13]
After treatment, some patients may receive maintenance therapy to help keep the cancer from coming back. This usually involves taking rituximab or obinutuzumab once every two months for up to two years.[10]
Outlook
The outlook for stage II follicular lymphoma is generally very good. The five-year survival rate for stage II follicular lymphoma is 90%, meaning that 9 out of 10 people are still alive five years after diagnosis.[5]
Follicular lymphoma is a slow-growing cancer, and many people live for many years with the condition. However, the disease often comes back (relapses) after treatment. When this happens, additional treatment is usually available. New treatments are helping people live longer with follicular lymphoma. Most people with this condition die with it, not from it.[1]
