DEAR DR. ROACH: I am an 86-year-old woman who was recently diagnosed with follicular lymphoma, stage 3A. It was discovered on a CAT scan when I went to the ER for diverticulitis. I have no symptoms. The doctor did a biopsy to confirm, and I had a PET scan as well. I feel good otherwise. I am only on blood pressure and cholesterol medications.
My oncologist recommends low-dose chemotherapy. At my age, what should I do? — L.H.
ANSWER: There are many types of lymphomas, which are a type of cancer of blood cells, but unlike leukemias, lymphomas are predominantly in the lymph nodes. Follicular lymphoma is an “indolent” type of lymphoma, meaning it is slow-growing, but unfortunately often uncurable. People with no symptoms from follicular lymphoma and who are stage 1, 2 or 3A tend to have a long time before they have progression of the disease to the point of having symptoms. Depending on other characteristics, that time ranges from an average of three to seven years. Choosing to hold off on treatment is definitely a reasonable option for someone like you.
However, your oncologist knows much more about your disease than I do, such as the extent of tumor in the abdomen, the molecular markers of the tumor and additional blood results. When an oncologist suggests treatment, I would listen carefully. One treatment that your oncologist might be considering is immunological therapy, such as rituximab. Unlike traditional chemotherapy, rituximab alone is pretty nontoxic and can delay the progression of the disease. A large study suggested improvement in the quality of life with the rituximab. Usually, rituximab is given once a week for four doses, but some oncologists repeat the four doses every two months.
If I had a patient in your situation, I would say holding off on treatment would be reasonable, given your age and lack of symptoms, but a trial of the rituximab (if that is what the oncologist is contemplating) would also be a reasonable choice. If you had serious side effects to the treatment, I would recommend against further doses.
