Follicular Lymphoma Stage III
Stage III follicular lymphoma is an advanced form of slow-growing cancer where abnormal white blood cells have spread to lymph nodes on both sides of the diaphragm—the muscle separating your chest from your abdomen.
Table of contents
What is Stage III Follicular Lymphoma
Follicular lymphoma is a type of non-Hodgkin lymphoma (cancer affecting the lymphatic system) that develops from abnormal B cells. These are white blood cells that normally help fight infections by making antibodies. The condition is called “follicular” because the abnormal cells usually grow in clusters called “follicles” inside lymph nodes.[1][2]
In stage III follicular lymphoma, cancer has spread to lymph nodes on both sides of your diaphragm—the band of muscle that separates your chest from your abdomen. This means lymph nodes above and below this muscle are affected by the disease.[1][4]
Follicular lymphoma is usually a slow-growing cancer. Because it often doesn’t cause symptoms early on, most people are diagnosed when they already have stage III or stage IV disease.[1][3]
Symptoms
Many people with follicular lymphoma have no symptoms at all when first diagnosed. When symptoms do appear, the most common is painless swelling in the neck, armpit, or groin. This swelling is caused by enlarged lymph nodes.[1][3]
Other symptoms that may occur include:
- Feeling very tired (fatigue)
- Fever that comes and goes with no clear cause
- Heavy sweating at night
- Unexplained weight loss, especially losing more than one-tenth of your body weight within six months
Doctors call these general symptoms “B symptoms.” They are important to report to your healthcare provider.[1][3]
If follicular lymphoma affects the bone marrow (the soft tissue inside bones where blood cells are made), it can cause additional problems such as low red blood cell counts leading to tiredness or breathlessness, or low platelet counts causing bruising or bleeding.[3]
Diagnosis and Testing
The main way to diagnose follicular lymphoma is through a lymph node biopsy, where a doctor removes all or part of a swollen lymph node. A specialist then examines it under a microscope to look for cancer cells.[1][3]
After confirming the diagnosis, your healthcare provider will order additional tests to determine the stage of the lymphoma. These tests may include:
- Blood tests to check overall health and rule out other conditions
- CT scans (computed tomography scans) that use X-rays to create detailed pictures of the inside of your body
- PET scans (positron emission tomography scans) that show how tissues and organs are functioning
- Bone marrow tests to check if cancer has spread to the bone marrow
These imaging tests help doctors see where cancer cells are located throughout your body and determine whether the lymphoma is on both sides of the diaphragm, which defines stage III disease.[1][3][4]
Treatment Options
Treatment for stage III follicular lymphoma depends on whether you have symptoms. If you don’t have any symptoms, you may not need treatment right away. Research shows that early treatment of symptom-free follicular lymphoma doesn’t improve survival. Instead, your provider may suggest active surveillance (also called “watchful waiting”), where they regularly monitor your condition. You would only start treatment if you develop symptoms or if the disease begins to progress.[1][4]
When treatment is needed for stage III follicular lymphoma, the main approach is chemotherapy to shrink or slow the cancer. This is often combined with targeted drugs called monoclonal antibodies, such as rituximab or obinutuzumab, which help the immune system attack cancer cells.[4][9]
Common chemotherapy combinations include:
- CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) with rituximab, used for more aggressive cases
- Bendamustine with rituximab
- CVP (cyclophosphamide, vincristine, and prednisone) with rituximab
- Other options like chlorambucil or lenalidomide combined with rituximab
For slowly growing tumors with low mass, rituximab may be used alone.[4][9]
After chemotherapy shrinks the lymphoma, you may receive maintenance therapy to help prevent the cancer from coming back. This usually involves taking rituximab or obinutuzumab once every two months for up to two years.[4][9]
Outlook
Follicular lymphoma is not currently curable, but new treatments are helping people live longer with the condition. It is a slow-growing cancer, and many people live with it for many years. Most people with follicular lymphoma die with the disease, not from it.[1]
Because stage III is considered advanced disease, treatment focuses on managing symptoms, slowing progression, and maintaining quality of life. The disease often responds well to initial treatment, though it may come back over time. Each time it returns, doctors can try different treatment approaches.[4]
Healthcare providers are hopeful that newer treatments, such as immunotherapy drugs and targeted therapies, may eventually lead to a cure for follicular lymphoma.[1]
