Physical Examination

A thorough physical examination of the patient should be conducted, with attention to node-bearing areas, including Waldeyer’s ring, and the size of spleen and liver.1 A physical exam should also include assessment of performance status and symptoms.1

Lymph nodes body diagram

The lymphatic system is shown in green in the image

Commonly examined areas include1:

  • Lymph nodes
    • Survey palpable lymph node areas throughout the body, including the axillary, femoral, and inguinal areas
    • Ask about the duration of enlargement and if waxing and waning (a potential indicator of FL) has occurred2
      • Note: patients with FL typically present with asymptomatic lymphadenopathy (large or swollen lymph nodes) at diagnosis.2

The lymphoid survey3:

Lymphoid survey callout box

Lymph nodes body diagram

The lymphatic system is shown in green in the image

  • Chest for pain, pressure, or symptoms of superior vena cava syndrome3
  • Abdomen for any masses as well as for splenomegaly (enlarged spleen) and hepatomegaly (enlarged liver)1,3
  • Head and neck to survey for palpable nodes and check Waldeyer’s Ring1
  • Involvement of other organs is uncommon in FL; however, a physical exam may include assessment of extranodal sites, including central nervous system (CNS), gastrointestinal (GI) tract, and skin1,2,3

References: 1. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for B-Cell Lymphomas V.4.2019. © National Comprehensive Cancer Network, Inc. 2019. All rights reserved. Accessed July 10, 2019. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way. 2. Freedman A. Follicular Lymphoma: 2018 Update on Diagnosis and Management. Am J Hematol. 2018;93:296-305. 3. Merck Manual. 20th ed. Lane KAG, ed. Rahway, New Jersey: Merck & Co., Inc. 2018.