Watching Follicular Lymphoma Carefully
- Follicular lymphoma, a type of non-Hodgkin lymphoma, is not considered curable for most people with the disease.
- Instead, it's generally considered more of a chronic disease, with doctors taking a watchful waiting approach.
- Radiation treatment may cure some patients who only have disease in one area.
In a group of patients, rather than treating follicular lymphoma immediately, doctors tend to take an approach known as watchful waiting or active surveillance.
Read MoreWhat Is Watchful Waiting?
There's no uniform approach to monitoring for follicular lymphoma. Rather, care teams typically try to avoid unnecessary imaging. Scans are not always vital. "It's impossible to tell you from day one of the diagnosis what exactly watchful waiting will mean," Dr. Svoboda explains. "In 2020, we are trying to limit the amount of imaging as much as possible."Dr. Svoboda further explains why frequent scans aren't typically part of best practices. "If the trigger to treat means the patient develops symptoms or abnormalities in the blood work, doing scans probably doesn’t make that much of a difference," he says.
For example, "If the lymph node moves from 2.1 centimeter to 2.8 centimeter, it will not necessarily make me start therapy or change the recommended therapy for the patient."
When Should People With Follicular Lymphoma Get Scans?
Scans are appropriate where it's not possible to feel the tumor, because imaging will help follow the enlargement. They are generally recommended once every year or six months, with closer observation after a year.
The frequency "depends on the situation," Dr. Svoboda explains. "But in my practice, often the first year after diagnosis I watch the patients a little bit closer."
A year after diagnosis, examinations may be done every four months. "So they may come to see me every three to four months for a good exam. They may do blood work every four months," he says. "And then as I get to know them, I get to know a little bit about the disease. If you have just only one time point, you may not know what’s going to happen, but if you have two or three time points, you get a sense about the biology of the disease in terms of the growth."
Active Surveillance
Active surveillance for people with follicular lymphoma means getting regular checkups for the rest of their lives with an annual checkup as a minimum recommendation to track the disease for most patients.
The group of patients with limited disease that is, those who have only follicular lymphoma in one area can be treated with radiation therapy for those localized areas. Some people with early-stage disease can be cured this way. Otherwise, the approach for most patients is watchful waiting.
"We continue to see them on a regular basis basically for the rest of their lives, and at minimum annually," Dr. Svoboda explains. That said, "there are some exceptions to the rule," noting those with localized disease.
"There are some people who have very limited follicular lymphoma when they present with just, let’s say, one area of involvement. And those patients actually we do treat," he says. He notes that this approach is "kind of ironic."
Why? Because, "Patients with the more advanced disease we do watchful waiting, and for patients who have just one single area of involvement we often treat with radiation."
Learn more about SurvivorNet's rigorous medical review process.