Tag Archive for: lymph node pain

Understanding Follicular Lymphoma Disease Progression Symptoms and Monitoring

Understanding Follicular Lymphoma Disease Progression Symptoms and Monitoring from Patient Empowerment Network on Vimeo.

How are follicular lymphoma symptoms and disease progression monitored? Expert Dr. Sameh Gaballa explains follicular lymphoma disease transformation, symptoms to be on the lookout for, and frequency of monitoring during watch and wait.

Dr. Sameh Gaballa is a hematologist/oncologist specializing in treating lymphoid malignancies from Moffitt Cancer Center. Learn more about Dr. Gaballa.

See More from START HERE Follicular Lymphoma

Related Resources:

Follicular Lymphoma Disease Transformation and Secondary Cancer Risk

Follicular Lymphoma Disease Transformation and Secondary Cancer Risk

Relapsed/Refractory Follicular Lymphoma Treatments and Bispecific Antibodies

Relapsed/Refractory Follicular Lymphoma Treatments and Bispecific Antibodies

How Can Follicular Lymphoma Treatment Side Effects Be Reduced?


Transcript:

Lisa Hatfield:

Although follicular lymphoma is a slow-growing cancer, can you speak to the signs that the disease is progressing in the body, what signs that patients might want to look out for?

Dr. Sameh Gaballa:

Yeah, absolutely. So, typically we educate the patients to there are some red flags to look out for, not just for progression,but also for another condition called disease transformation. So, follicular lymphoma does have a, there is a possibility that it can transform from a slow-growing lymphoma to an aggressive lymphoma. Now, this happens at a rate of about maybe 2 to 3 percent per year, but it’s a cumulative risk, so meaning if a patient lives many, many decades, their lifetime risk can be up to as high as 20, 25 percent, 30 percent, depending on the different literature, so there is a chance that these slow-growing lymphomas can transform to an aggressive lymphoma.

And when they do know this, there’s no watch and wait for transformed disease. It has to be treated with chemo immunotherapy because the goal of treatment then is to try to get rid of the aggressive component. What are the signs and symptoms to suggest that you might have transformed disease? This is not something that the patient would typically need to look out for. I tell my patients that, “You don’t need to see, do I have transformed disease or not. This is going to come, and you’re going to know when you have transformed disease. Extreme fatigue, drenching night sweats, the fever sometimes that are not going away.”

The patient might have pain if the lymph node is pressing on some important structure. They may have loss of appetite, loss of weight. So again, something that dramatically happens quickly over a few weeks of time. So if the patient feels sick for one reason or another and they’re not getting better, it can all happen within a few weeks’ time frame. This is the time to get checked early on and go see your oncologist, because then we might need to investigate if there is any potential for transformation. So that’s issue number one.

Issue number two is, which is the much more common scenario, which is the follicular lymphoma is slowly progressing. How would you know? I mean, if you notice a lymph node that in your neck or under the armpits or the groin areas, if they’re growing, then that needs to be evaluated. I mean the patients should expect that those will be growing, they will grow. But they grow over months and years. They don’t grow over weeks.

So anytime you kind of are unsure, if you feel that it’s growing faster than usual, this is, again, something to look out for. And then the B symptoms that I mentioned. So like the sweats, the fevers, the weight, loss of weight, loss of appetite, these are also sometimes things to look out for. Not necessarily, they don’t always mean that it’s transformed disease. It can also be that the follicular lymphoma is also progressing and might need to be treated as well.

Lisa Hatfield:

And then just a quick follow-up to that question. So a patient is watching out for these red flags, but are they going through any kind of regular monitoring in your office? Are you meeting with them on a regular basis? And how frequent might that be for a follicular lymphoma patient who’s watching and waiting?

Dr. Sameh Gaballa:

Yeah. So how does watch and wait look? So, and I tell patients always watch and wait does not mean ignore. Watch and wait means that we’re monitoring the disease, we’re looking at it. How do we do that? So typically we would see the patient maybe every three to six months. And then depending on how do we, when we get a sense or tempo of how their disease is progressing, then we’ll know how often we need to see them. I’ve had, I still have patients where I’m seeing them every three months. And I also have some patients where the disease has been stable for years, I only see them once a year. In terms of imaging, that’s also sometimes an area of controversy. Typically, initially for the first maybe year or two years, I do like a scan, like a CT scan every six months, just to get a sense of how quick or how slow the disease is progressing. If there’s absolutely no change at all, then sometimes we either don’t do scans and just go by the patient’s symptoms and blood work and physical exam, or we do maybe once a year scan but not more than that. So this is how we would monitor the patients in a watch-and-wait approach.


Share Your Feedback:

Create your own user feedback survey

Should CLL Patients Worry About Enlarged Lymph Nodes?

Should CLL Patients Worry About Enlarged Lymph Nodes? from Patient Empowerment Network on Vimeo.

Should chronic lymphocytic leukemia (CLL) patients be concerned about enlarged lymph nodes? Expert Dr. Ryan Jacobs shares his perspective on when his patients start treatment due to lymph node enlargement and additional symptoms that become concerning. 

Dr. Ryan Jacobs is a hematologist/oncologist specializing in chronic lymphocytic leukemia from Levine Cancer Institute. Learn more about Dr. Jacobs.

See More from START HERE CLL

Related Programs:

Can CLL Remission Occur With Rheumatoid Arthritis Drug Treatments?

Can CLL Remission Occur With Rheumatoid Arthritis Drug Treatments?

Reasons to Get Chronic Lymphocytic Leukemia Second Opinions

Reasons to Get Chronic Lymphocytic Leukemia Second Opinions

Can Bone Marrow Return to Normal After CLL Treatment?

Can Bone Marrow Return to Normal After CLL Treatment?


Transcript:

Lisa Hatfield:

So this patient is asking, “When you are in the watch-and-wait phase and are feeling lymph nodes getting bigger, when is it appropriate to contact your oncologist?”

Dr. Jacobs:

This is a question that comes out a lot with my CLL patients. It’s a very subjective thing. Lymph node pain, that’s what’s supposed to trigger needing treatment for CLL from a lymph node standpoint. Technically speaking, if there’s a lymph node bigger than 10 centimeters, we’re supposed to start treatment. That’s one of the criteria too. That’s one that I almost never see, because usually patients get uncomfortable with their lymph nodes or their disease progresses elsewhere significantly before a lymph node gets that big.

So discomfort or pain, and that’s up to the patient, and I tell them like, “You have to tell me if this is bad enough that you want to start treatment.” And I have patients that are very different in how they interpret that. And I’ve got some patients that have visibly enlarged neck nodes and have had it for a while, and they don’t feel like they’re bothered by them, even though they’re quite chunky.

And then I have patients that have had lymph nodes that aren’t that big that really bother them. And so we start treatments. It’s just a very subjective thing. The only part I would identify is, you don’t need to just call your oncologist if you’re just noticing a little bit of growth or a node here and there, that’s expected. If you’re on active surveillance, it is expected that over time most patients’ white count will go up. Not all, most patients’ lymph nodes will grow. Not all.

The reason I would call an oncologist to maybe schedule earlier follow-up is if there’s accelerated growth that’s persistent and maybe if it’s associated with new symptoms like feeling really badly, fevers, waking up drenched in sweat. These are all signs that maybe the lymphoma has transformed to a more aggressive type of lymphoma that’s called Richter’s transformation. So that’s when I would be concerned. But low level chronic growth that’s relatively asymptomatic, is not overly concerning. 

Lisa Hatfield:

Hey, as a blood cancer patient, the limited duration treatment sounds like a dream. So this patient is asking, is there a time-limited pill-only treatment regimen yet, or is one in the pipeline?

Dr. Jacobs:

If you live in Europe, ibrutinib (Imbruvica) and venetoclax (Venclexta) got approved. I did a lot of research on that study. The FDA didn’t look as favorably on the comparison arms of the trials that led to the approval in the EU. So we do not have FDA approval. It is on the NCCN guidelines, as an option in…or as another option, that you can consider. The research is ongoing into getting the venetoclax combination approved with the newer BTK inhibitors. I currently am putting a lot of patients on a trial that’s looking at acalabrutinib and venetoclax. So I do think we will have, for some patients, the option, that for some patients that want it, and that seem to fit the, what we ultimately decide is the best patient population for this combination, the option to give a combination of pills for a time-defined period.


Share Your Feedback

Create your own user feedback survey