Follicular Lymphoma

Follow-Up Care & Support

Although follicular lymphoma may go into remission, the disease may relapse (come back) after initial treatment. For this reason, follow-up care and healthy living are extremely important. Monitoring your health will be key to achieving these goals. Although follicular lymphoma is difficult to cure, it is highly treatable. Doctors typically will focus on maintaining or controlling the disease while minimizing any symptoms related to the follicular lymphoma.

Monitoring Your Health

After your initial treatment for follicular lymphoma is complete, your doctor will design a follow-up care plan to monitor your health and check for a potential relapse. For this plan to be useful, you must understand and follow it exactly. If you have any questions or concerns as your follow-up care plan is being developed, don’t hesitate to talk to your doctor.

Your follow-up care plan likely will include regular physical examinations, blood tests and/or computed tomography (CT) (See Diagnosis for more information about these procedures). If signs of relapse are detected, your doctor will talk to you about new treatment options (See “Treatment for Relapsed Disease” on Treatment page). It is important to keep personal health care records of all of your medications and doctor appointments. One way to keep track is to use the “My Medical Journal” (download the journal here).

In addition to follow-up appointments, it is important to report any side effects or symptoms to your doctor. Honest and timely reporting of how you feel can assist your doctor in managing your disease. Record and describe any changes you experience that are unexplained and persistent, such as pain, fatigue, abnormal bowel and kidney function, fevers and sweats.

Although follow-up care is important for survivors of all types of cancer, it’s especially important for people who have had follicular lymphoma because multiple relapses often occur.

Living A Healthy Lifestyle

Perhaps as important as sticking to your follow-up care schedule and managing side effects is staying healthy and active. It’s important to maintain good nutrition, be as active as you can, get enough rest and be emotionally healthy. Taking these actions can help you feel better both physically and psychologically, allowing you to better cope with the day-to-day challenges of living with follicular lymphoma.

Maintain Good Nutrition

It’s important to make healthy choices before, during and after treatment. This can be a challenge if you have side effects, such as loss of appetite, nausea or vomiting. A healthy diet rich in protein can help you gain strength, which is especially needed during treatment cycles. In general, try to eat a wide variety of nutrient-rich foods and drink plenty of liquids. Because some cancer treatments can cause loss of bone mass, it is helpful to eat dairy foods and other foods high in calcium. Talk to your doctor or a registered dietitian about the need for calcium and vitamin D, either in your diet or as supplements.

Understanding Good Nutrition

Treating follicular lymphoma may cause a loss of appetite, nausea or vomiting, or a change in your sense of taste, which could make it difficult to eat and maintain your weight. Eating enough high-quality food that is rich in nutrients is important for good health and can support you in your recovery. If you find it difficult to eat, consider eating small portions instead of three big meals a day.

A healthy diet is made up of different food groups that give your body nutrients. These include carbohydrates, protein, fat, fiber, and vitamins and minerals. Carbohydrates are starchy foods, such as rice, bread and pasta. For a healthier option, choose brown, whole grain or whole meal varieties.

A diet high in protein is often recommended for people receiving treatment. Protein helps your body grow and repair itself as you are healing. Foods high in protein include meat, fish, eggs, beans and lentils. Dairy products also contain some protein, calcium and zinc. If you are trying to gain weight, choose full fat options instead of low-fat or non-fat options.

Fats provide an important source of energy and vitamins and often help you feel full. Unsaturated fats are considered heart healthy and may lower your cholesterol. Good examples of food containing unsaturated fats include avocados, Brazil nuts and oily fish. Saturated fats are found in foods such as butter, meat and many processed foods, such as sausage, and should be limited in your diet.

Vitamins and minerals help boost your immune system and keep your bones, teeth and skin healthy. Fruits and vegetables are good sources of vitamins and minerals. It is recommended that you eat at least five servings of fruits and vegetables a day. Fruits and vegetables are also a good source of fiber, which helps your digestive system to function best. Fiber can also be found in cereals and potatoes.

Vitamin D is recommended for people with follicular lymphoma because a lack of vitamin D can contribute to bone loss and other types of cancers. Your doctor can perform a blood test to determine if your vitamin D level is low. To increase your vitamin D level, doctors typically recommend 15 minutes in the sun three days a week or taking supplements. Your doctor will recommend how much to take on a daily basis.

Although sugar may be a good source of energy, it generally is recommended to limit the amount you eat. However, if you are losing weight, adding sugar to your diet may help slow weight loss or gain weight.

Side effects experienced during treatment can affect the ability and joy of eating. Nausea, sore mouth and changes in taste can prevent you from eating. For nausea, antiemetics (anti-sickness medications) are available, and you can try dry, plain foods, such as toast, crackers or rice. For mouth sores, some mouthwashes may be available to try. Many people report changes in how food tastes, saying it is too bland or bitter or has a metallic taste. Adding extra flavoring to foods may help improve the taste. Consider using different herbs, spices and sauces.

Be Active

Participating in physical activities or regular exercise can help you feel better overall. Although it may not seem to make sense, physical exercise is actually the best treatment for fatigue. Studies have shown that people with cancer who exercise regularly feel less tired and have more energy. Weight-bearing activities, such as walking, can help strengthen bones, which is important if you have bone metastasis. Think about what type of physical activity you enjoy most, and engage in it daily, or as often as you can tolerate. Try to modify your favorite form of exercise if you experience any pain or discomfort, rather than discontinue it.

Get Enough Rest

Sleep disturbances are common among people with cancer. One reason is that fatigue related to cancer and its treatment leads people to take frequent naps during the day, which then makes it difficult to sleep at night. You can still set aside time in your day to rest or take naps, but limit them to 20 to 30 minutes each, and avoid napping in the late afternoon or early evening. Your doctor may review the medications you are taking and change them if drug interactions or side effects are contributing to your sleep problems. Your doctor may also recommend a medication to help you sleep.

Stay Emotionally Healthy

Living with cancer can often feel like being on an emotional rollercoaster. Allow yourself to express your emotions freely. Finding ways to reduce and manage stress will strengthen your coping abilities. Some possibilities are journaling, meditation, guided imagery, muscle relaxation and yoga. Ordinary “escapes,” such as reading, television and games, can help you relax. You must also be alert to depression and seek help if you’re experiencing a depressed mood and a loss of interest or pleasure in normal activities. Maintaining relationships and participating in support groups — either in-person or online — can go a long way toward helping you stay emotionally healthy.

Managing Late Effects

In addition to watching for signs of disease relapse, your doctor will use your follow-up care visits to check for long-term side effects, which are also called late effects. These can begin weeks, months or even years after your treatment ends, and they vary based on your overall health and the type of treatment you received.

Each treatment option offers its own possible late effects. Before you begin treatment, ask your health care team about what symptoms, including late effects, to expect. Be prepared to call your doctor right away if you have any concerns.

Some common late effects of follicular lymphoma treatments include reduced fertility, fatigue, peripheral neuropathy, heart problems, stroke, lung damage, shortness of breath, thyroid problems and increased risk for infection.

One late effect from high-dose chemotherapy is the risk for a second cancer, which is a different cancer than follicular lymphoma. The second cancers that have been linked to chemotherapy treatment for lymphoma include leukemia, lung cancer, brain cancer, kidney cancer, bladder cancer, melanoma and Hodgkin lymphoma.

The use of certain chemotherapy drugs also has been associated with heart problems because they can weaken or damage the heart muscle. Higher doses and more frequent use increase the risk. This late side effect typically occurs 10 years or more after treatment.

Some uncommon late effects from chemotherapy include problems with your teeth and eyes, including cataracts and glaucoma.

Late effects from radiation therapy also are possible and can include problems with your lungs, teeth, eyes, heart and thyroid.

If you stay on top of your follow-up care plan, these late effects often can be managed, allowing you to maintain a high quality of life. Attend follow-up appointments, get to know what is normal for you, get regular check-ups with your dentist and eye doctor, and discuss other cancer screening programs that you may need in addition to your treatments.