Follicular lymphoma
Follicular lymphoma is a form of non-Hodgkin lymphoma that may appear in your lymph nodes, bone marrow and other organs. Non-Hodgkin lymphoma (NHL) is cancer that affects your lymphatic system. Follicular lymphoma is the second most common type of NHL, with about 15,000 to 20,000 new diagnoses in the U.S. each year.
Follicular lymphoma is an indolent (slow-growing) cancer. But there’s a small chance it can progress to a more aggressive cancer called diffuse large B-cell lymphoma.
It’s not curable — at least not yet. But new treatments are helping people live longer with follicular lymphoma. Most people with this condition die with it, not from it.
You can have follicular lymphoma without having any symptoms. When people do have them, the ones that usually show up are painless swelling in the neck, armpit or groin. This is a sign of enlarged lymph nodes.
Other symptoms include:
- Fatigue
- Fever
- Night sweats and chills
- Unexplained weight loss (especially losing 10% or more of your weight within the past six months)
Researchers don’t know what causes follicular lymphoma. They do know changes in people’s chromosomes happen in about 85% of cases. The changes transform normal B cells into cancer cells.
B cells are white blood cells that make antibodies to fight infections. But cancer cells don’t function in this way. Instead, they multiply and grow. Eventually, they may cause symptoms.
These changes happen at some point in your lifetime. Follicular lymphoma isn’t inherited.
People age 65 and older are more likely to have this condition. People who are white receive this diagnosis more often than people of other races.
Children can develop follicular lymphoma. But it’s so different from the adult form that researchers consider it a different type of cancer. Unlike the adult type, pediatric follicular lymphoma is often curable.
Having a biopsy done is the only way to know for sure if you have follicular lymphoma. After confirming your diagnosis, your healthcare provider will order tests to stage it. Cancer staging can show how early or advanced the disease is. You may need:
- Blood tests
- PET scans
- CT scans
Stages of follicular lymphoma
Follicular lymphoma stages range from I to IV:
- Stage I: Cancer is in one or more lymph nodes.
- Stage II: Cancer is in lymph nodes above or below your diaphragm. Your diaphragm is a band of muscle that separates your chest from your abdomen.
- Stage III: Cancer is in lymph nodes on both sides of your diaphragm.
- Stage IV: Cancer has spread beyond your lymph nodes.
Since follicular lymphoma doesn’t cause symptoms right away, most people have Stage III or IV disease by the time they’re diagnosed.
You may not need treatment if you don’t have symptoms. Research shows that early treatment of asymptomatic follicular lymphoma doesn’t improve survival. Instead, your provider may suggest active surveillance. They’ll check on your condition regularly. You’ll only get treatment if you develop symptoms that treatment can ease or that keep the disease from getting worse.
Treatments include:
- Radiation therapy: Providers often use radiation therapy to treat Stage I follicular lymphoma. In about half of people, it sends the cancer into long-term remission. This means there are no signs or symptoms of cancer.
- Chemotherapy: You may need chemotherapy with or without immunotherapy. For many people, it sends the cancer into remission.
- Immunotherapy: You may need immunotherapy alone or with chemotherapy. It helps people achieve and stay in remission. New immunotherapy drugs treat lymphoma that comes back (relapsed disease).
- Targeted therapy: This treatment targets cancer cell weaknesses related to certain mutations. It treats some forms of follicular lymphoma that relapse.
- Stem cell transplant: This treatment sends healthy blood-forming cells into your body to replace the cancer cells. You may need this treatment if follicular lymphoma comes back. But it carries risks. So, it’s not an option for everyone.
Experts are constantly finding new treatments that work on follicular lymphoma. In particular, immunotherapy drugs like rituximab have been a game-changer for people with this diagnosis. Researchers are hopeful that follicular lymphoma may one day be curable.
What can I expect if I have this condition?
Follicular lymphoma is a slow-growing condition that’s considered a chronic illness. About half of all people diagnosed with it are alive 20 years later. About 9 out of 10 of people are alive five years after diagnosis. Since most people diagnosed are over 50, this means that many people eventually die of causes unrelated to the cancer.
But there are lots of ways this disease can unfold. You may never need treatment, or you may develop more aggressive disease, like diffuse large B-cell lymphoma. Your chances of cancer progression increase slightly each year.
Managing the disease in the long term often becomes a way of life with this diagnosis.
Is there anything I can do to feel better?
Your healthcare provider can suggest ways to cope with a lymphoma diagnosis. You may be living with cancer for a long time. Long-term survival is good news, of course, but living with a chronic illness may be challenging.
Making changes to your diet may help you feel better. Talking to a therapist or finding a support group can help, too. Finding cancer survivorship support is an important part of living with this disease.
References
- Friedberg JW. Update on follicular lymphoma (https://pubmed.ncbi.nlm.nih.gov/37294960/). Hematol Oncol. 2023 Jun;41 Suppl 1(Suppl 1):43-47. Accessed 10/20/2025.
- Jacobsen E. Follicular lymphoma: 2023 update on diagnosis and management (https://pubmed.ncbi.nlm.nih.gov/36255040/). Am J Hematol. 2022;97(12):1638-1651. Accessed 10/20/2025.
- Kaseb H, Ali MA, Gasalberti DP, et al. Follicular Lymphoma (https://www.ncbi.nlm.nih.gov/books/NBK538206/). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan. Accessed 10/20/2025.
- Merryman R, Mehtap Ö, LaCasce A. Advancements in the Management of Follicular Lymphoma: A Comprehensive Review (https://pubmed.ncbi.nlm.nih.gov/38660754/). Turk J Haematol. 2024 May;41(2):69-82. Accessed 10/20/2025.
- National Cancer Institute (U.S.). Surveillance, Epidemiology, and End Results Program. Cancer Stat Facts: NHL– Follicular Lymphoma (https://seer.cancer.gov/statfacts/html/follicular.html). Accessed 10/20/2025.
- National Organization for Rare Disorders (U.S.). Follicular Lymphoma (https://rarediseases.org/rare-diseases/follicular-lymphoma/). Updated 7/18/2025. Accessed 10/20/2025.
- Pongas G, Cheson B. Recent Advances in the Management of Patients with Relapsed/Refractory Follicular Lymphoma (https://pmc.ncbi.nlm.nih.gov/articles/PMC8331102/). Blood Lymphat Cancer. 2021 Jul;11:55-66. Accessed 10/20/2025.
- The Follicular Lymphoma Foundation. Diagnosis and Signs of Follicular Lymphoma (https://www.theflf.org/your-support-hub/understanding-fl/diagnosis/#symptoms). Accessed 10/20/2025.
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