Follicular Lymphoma

Overview

What is follicular lymphoma?

Follicular lymphoma is a very slow-growing cancer that may appear in your lymph nodes, your bone marrow and other organs. You can have follicular lymphoma without having symptoms. Healthcare providers consider follicular lymphoma a chronic illness. There are ways to treat follicular lymphoma, but the condition often comes back. Healthcare providers are hopeful newer treatments may mean a cure for follicle lymphoma is on the horizon.

Who is affected by follicular lymphoma?

Approximately 3.5 people in 100,000 have follicular lymphoma. People age 65 and older are more likely to have this condition than younger people, and males are more likely than females to develop follicular lymphoma.

How does follicular lymphoma affect my body?

Follicular lymphoma is a subtype of B-cell lymphoma, a form of non-Hodgkin’s lymphoma. Follicular lymphoma symptoms mirror non-Hodgkin lymphoma symptoms, such as swollen lymph nodes, fever and drenching night sweats.

But many people are diagnosed with follicular lymphoma before they develop symptoms. People who’re in good health and don’t have symptoms may not need immediate treatment. Healthcare providers may recommend watchful waiting. In watchful waiting, healthcare providers monitor your overall health and symptoms.

Follicular lymphoma may affect your emotional well-being long before it affects your physical well-being. A recent study showed people with follicular lymphoma and other slow-growing lymphomas struggle with anxiety because they don’t know if they’ll develop symptoms or need to start treatment.

Is follicular lymphoma a serious illness?

Yes, follicular lymphoma can be a serious and challenging illness. Here’s why:

  • Transformation: Follicular lymphoma can change or transform into diffuse large B-cell lymphoma (DLBCL). This is a more aggressive cancer that typically causes new and more significant symptoms, including spreading cancer into other areas of your body. About 3 % of people who have follicular lymphoma develop DLBCL.
  • Relapse: Follicular lymphoma symptoms often subside after treatment and then come back. This cycle of remission-relapse-remission means people who have follicular lymphoma feel as if they’re never able to say they’re “done” with treatment.

Symptoms and Causes

What are the signs and symptoms of follicular lymphoma?

General symptoms may include:

  • Painless swelling in your neck, armpit or groin caused by enlarged lymph nodes.
  • Fever that infection or other illness is causing.
  • Weight loss with no known cause, particularly losing 10% or more of your weight within the past six months.
  • Sweating and chills. Drenching night sweats and chills that don’t go away may be a sign of illness, including follicular lymphoma.
  • Fatigue. This is an ongoing sense of feeling so tired that you can’t manage your daily activities.

What causes follicular lymphoma?

Researchers don’t know all of the factors that cause follicular lymphoma. They do know changes in people’s chromosomes cause about 85% of cases. The changes allow unhealthy or cancerous cells to multiply and grow.

Diagnosis and Tests

How do healthcare providers diagnose follicular lymphoma?

Healthcare providers may use several tests to diagnose follicular lymphoma:

  • Biopsy: Healthcare providers may take lymph node tissue samples to test for signs of cancer.
  • Positron emission tomography (PET) scans: Healthcare providers use this test to observe cancer cell activity and establish a cancer grade.
  • Computed tomography (CT) scan: This test helps healthcare providers monitor cancer and evaluate treatment response.

What are the stages of follicular lymphoma?

Healthcare providers establish cancer stages so they know what kind of treatment may be best to treat the cancer. Follicular lymphoma stages range from I to IV:

  • Stage I: Cancer is found in one or more lymph nodes. Healthcare providers diagnose about 25% of all follicular lymphoma cases at this stage.
  • Stage II: Cancer is found in lymph nodes above or below your diaphragm. Healthcare providers diagnose about 15% of all follicular lymphoma cases at this stage.
  • Stage III: Cancer is found in lymph nodes on both sides of your diaphragm. Healthcare providers diagnose about 26% of all follicular lymphoma cases at this stage.
  • Stage IV: Cancer has spread outside of the lymph nodes to bone marrow and/other organ systems. Healthcare providers diagnose about 27% of all follicular lymphoma at this stage.

Management and Treatment

How do healthcare providers treat follicular lymphoma?

Healthcare providers may use a combination of watchful waiting and therapy to treat follicular lymphoma. Here’s more information about each potential treatment:

  • Watchful waiting or active surveillance: If your healthcare provider recommends watchful waiting, you’ll have regular appointments so they can do physical examinations, laboratory tests and imaging tests.
  • Radiation therapy: Healthcare providers may use radiation therapy to treat early-stage follicular lymphoma.
  • Monoclonal antibody therapy: Healthcare providers use lab-created antibodies designed to find and kill specific cancer cells.
  • Chemotherapy: Healthcare providers may use chemotherapy alone or combine chemotherapy with other treatments.
  • Targeted therapy: Targeted therapy uses drugs or other substances to attack cancer cells without hurting normal cells.
  • Immunotherapy: Immunotherapy stimulates your immune system. Treatments can fuel your body’s production of cancer-fighting cells or help healthy cells identify and attack cancer cells.
  • Bone marrow/stem cell transplantation: Healthcare providers may recommend this treatment if follicular lymphoma comes back after chemotherapy.

Prevention

Can follicular lymphoma be prevented?

Unfortunately, researchers haven’t identified ways to reduce the risk of developing this condition. If you’re concerned you may be at risk, ask your healthcare provider to review your medical history, including your family medical history.

Outlook / Prognosis

How long can you live with follicular lymphoma?

Follicular lymphoma is a slow-growing condition that’s considered a chronic illness. Studies about half of all people diagnosed with follicular lymphoma are alive nearly 20 years after diagnosis. About 90% of people are alive five years after diagnosis.

Living With

How do I take care of myself?

Self-care is an important part of living with cancer. Self-care suggestions include:

  • Establish good eating and exercise habits. Ask to speak with a nutritionist for healthy menu ideas.
  • Fatigue is a common symptom and treatment side effect. Pay attention to your body and rest when you need to rest, not just when you can.
  • You may be living with cancer for a long time. That’s good news of course, but chronic illness may be challenging. Talking to a therapist or finding a support group may help you navigate the challenges.

When should I see my healthcare provider?

If you’ve been diagnosed with follicular lymphoma, your healthcare provider will set a schedule of follow-up appointments to monitor your condition and/or your treatment. But you should contact your healthcare provider as soon as possible if you notice changes in your body that may be signs of follicular lymphoma symptoms.

A note from Cleveland Clinic

Cancer is never easy, even a slow-growing form of cancer like follicular lymphoma. People who have follicular lymphoma may not have symptoms for several years. But when they do, they may find themselves cycling treatment, remission, relapse and then more treatment, with no end or cure in sight. But researchers are using different treatments that may do more to move follicular lymphoma from the list of chronic diseases to the list of curable diseases. If you have follicular lymphoma, talk to your healthcare provider about your treatment options.

Last reviewed by a Cleveland Clinic medical professional on 03/25/2022.

References

  • American Cancer Society. Survival Rates and Factors that Affect Prognosis (Outlook) for Non-Hodgkin Lymphoma. (https://www.cancer.org/cancer/non-hodgkin-lymphoma/detection-diagnosis-staging/factors-prognosis.html) Accessed 3/25/2022.
  • American Society of Clinical Oncology. Lymphoma-Non-Hodgkin: Subtypes. (https://www.cancer.net/cancer-types/lymphoma-non-hodgkin/subtypes) Accessed 3/25/2022.
  • Cancer.net. Lymphoma-Non-Hodgkin: Types of Treatment. (https://www.cancer.net/cancer-types/lymphoma-non-hodgkin/types-treatment) Accessed 3/25/2022.
  • Howell DA, McCaughan DG, Smith, AG. Incurable but treatable: Understanding, uncertainty and impact in chronic blood cancers-A qualitative study from the UK's Haematological Malignancy Research Network. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8830712/) PLoS One. 2022;17(2):e0263672. 2022 Feb 10. Accessed 3/25/2022.
  • Hübel K, Ghielmini M, Ladetto M, Gopal AK. Controversies in the Treatment of Follicular Lymphoma. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7000465/) Hemasphere. 2020;4(1):e317. 2020 Jan 10. Accessed 3/25/2022.
  • Matasar MJ, Luminari S, Barr PM, et al. Follicular Lymphoma: Recent and Emerging Therapies, Treatment Strategies, and Remaining Unmet Needs. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6853118/) Oncologist. 2019;24(11):e1236-e1250. Accessed 3/25/2022.
  • National Cancer Institute. Adult Non-Hodgkin Lymphoma Treatment (PDQ®) (https://www.cancer.gov/types/lymphoma/patient/adult-nhl-treatment-pdq) — Patient Version. Accessed 3/25/2022.
  • National Cancer Institute. Cancer Stat Facts – Follicular Lymphoma. (https://www.cancer.gov/types/lymphoma/patient/adult-nhl-treatment-pdq) Accessed 3/25/2022.
  • Pongas G, Cheson B. Recent Advances in the Management of Patients with Relapsed/Refractory Follicular Lymphoma. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8331102/) Blood Lymphat Cancer. 2021;11:55-66. 2021 Jul 30. Accessed 3/25/2022.
  • The Follicular Lymphoma Foundation. Diagnosis and Signs of Follicular Lymphoma. (https://www.theflf.org/diagnosis) Accessed 3/25/2022.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy