Can I wait for 3 months for my stage 3 follicular lymphoma?

Question

Hello doctor,

About two months ago, I had a physical illness, and my doctor found a mass under my right armpit. I was sent for an ultrasound, needle biopsy, blood test, and a pet test. I was told that I had follicular lymphoma, stage 3.

I was upset and in tears. My doctor told me that follicular lymphoma was a slowly progressing cancer and responded very well to chemotherapy, after all of these tests and verification of what I had. My oncologist said he would send me home for three months, then at the next appointment, he would decide on further tests and or treatment.

As the doctor said, this is cancer, and what do you think about being sent home for three months for a watch and wait?

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

So I would start by saying that follicular lymphoma is the most common low-grade lymphoma diagnosed in this age group. An incidentally detected lump is the most common way in which follicular lymphoma presents, as was the case in your case. After histological confirmation, staging is usually done with a PET scan. This shows stage III disease as per your query. Ideally, I would like to know a few things, like,

Confirmation of stage and grade.
Any symptoms like fever or weight loss.
CBC (complete blood count) and liver and renal functions.
Also, a report of a pet CT to look for any bulky disease.

Because in case of stage III or IV follicular lymphoma, there are certain indications for treatment, such as,

Local symptoms due to progressive or bulky nodal disease
Compromise of normal organ function due to progressive or bulky disease
Presence of systemic B symptoms (i.e., fevers, weight loss, night sweats)
Presence of symptomatic extranodal disease, such as effusions
Cytopenias due to extensive bone marrow infiltration, autoimmune hemolytic anemia or thrombocytopenia, or hypersplenism.
An increase in disease tempo (these are collectively called GELF criteria or BNLI criteria).

If these indications are not fulfilled, standard guidelines advise observation with follow-up. If a physician feels some indications are borderline, a decision is usually made to follow up to see the pace of the disease and then decide whether treatment is needed. If all these things are negative, I would say that a decision for your follow-up is ideal.

If you have any further questions, I would be happy to help you.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

I think you can attach your reports to this app in PDF format, so I can have a look at them. As far as your PET (positron emission tomography) report is concerned, whatever you have mentioned is a normal part of the report, but I think it is not complete. It would be better if you could attach your reports here so I can have a look and better help you.

I hope this helps you.

Thank you.