Follicular lymphoma symptoms and diagnosis

You’ll have these tests to confirm whether you have follicular lymphoma and check your general health:

• Lymph node biopsy: This involves taking a small sample of a swollen lymph node to confirm the diagnosis of lymphoma.
• Full blood count: This is a blood test which checks if you have developed anaemia (a low level of red blood cells which can lead to tiredness and breathlessness).
• Liver function test: This is a blood test that checks how well your liver is working.
• Urea and electrolytes test: This is a blood test that checks how well your kidneys are working.
• Infection screening: As your immune system may be weaker than usual, you’ll be tested for viruses which could make you ill very quickly, including hepatitis B, hepatitis C and HIV.
• Genetic tests: These look for specific abnormalities in your lymphoma cells which can help doctors decide on the best treatment.

We have more information on blood cancer tests.

You’ll also need tests to show how much the lymphoma has grown and developed. Doctors call this ‘staging’ the lymphoma, or they’ll refer to the ‘stage’ of the condition. Staging describes the nature of the lymphoma and where it is.

Knowing the stage of your lymphoma will help your healthcare team decide whether you should start treatment, and which treatment is right for you.

There’s a standard system which all doctors use to stage lymphoma. It’s based on how many areas of your body are affected by the lymphoma, and on your symptoms. If you have B symptoms, this is shown by the letter ‘B’. If you don’t have B symptoms, this is shown by the letter ‘A’. You can have A or B symptoms at any of the numbered stages.

Stages I or II with no B symptoms are described as early-stage disease. Stages I and II with B symptoms, stage III and stage IV are all classed as advanced-stage disease. This difference is important because sometimes there are different treatment options for early-stage and advanced-stage disease.

To stage the lymphoma, you may have one or more of these scans:

• X-ray
• CT scan
• PET scan
• MRI scan
• Ultrasound scan

Find out more about scans to investigate blood cancer.

You may have a sample of your bone marrow (a biopsy) taken soon after you’re diagnosed, to see whether your bone marrow is affected by lymphoma. This is called a bone marrow biopsy and gives doctors another opportunity to check your diagnosis and get more information about your condition.

We have more information on bone marrow tests.

Your doctors will also do several other tests on your blood or bone marrow samples. These provide ‘prognostic markers’ – information that helps predict how well your treatment is likely to work.

You’ll have a test that looks at the level of a protein called beta-2 microglobulin (B2M – sometimes written as ß2M) in your body. Some people with NHL will have higher amounts of B2M than normal, and this can tell doctors how advanced the follicular lymphoma might be.

When cells break down, they release a chemical called lactate dehydrogenase (LDH). If you have follicular lymphoma, you can have more LDH in your body because more cells are being produced and broken down. Knowing how much LDH is in your body can tell doctors how advanced the lymphoma might be. It’s very common for the LDH level to be normal in low-grade (slow-growing) NHL and raised in high-grade (fast-growing) NHL.

If you have a follicular lymphoma, doctors will grade the disease as well as staging it. Grading is another way of measuring the progress of follicular lymphoma and looks at cells called centroblasts. It measures the proportion of centroblast cells compared to other blood cells. This can help doctors work out how fast the lymphoma is growing and decide on the best treatment.

Follicular lymphoma is given a grade from 1 to 3. Grade 3 can be divided into 3A and 3B (in grading, the A and B aren’t related to symptoms). Grades 1, 2 and 3A will be treated as follicular lymphoma. Grade 3B follicular lymphoma will be treated as a high-grade (fast-growing) non-Hodgkin lymphoma.

There are several things doctors will consider to help them predict how well treatment will work. This is known as risk scoring.

The things your doctor will consider include:

• your age
• your performance status − how well you manage in daily life at home (for instance, how independent you are)
• the stage of your lymphoma
• the level of a protein called haemoglobin in your blood
• the levels of a substance called lactate dehydrogenase (LDH) in your blood
• the level of a substance called B2 microglobulin or B2M (sometimes written as ß2M) in your blood
• the size of the largest mass of cancer cells (the largest swollen lymph node or nodes)
• any signs that your bone marrow is affected