Follicular lymphoma tends to grow slowly and often doesn’t cause symptoms in its early stages. Swollen lymph nodes — typically in your armpits, neck, groin, and thighs — are usually the first symptom.

Lymphoma is a group of cancers that develop in your lymphatic system. This is made up of:

  • lymph nodes
  • lymph vessels
  • organs such as your spleen and tonsils

Follicular lymphoma is a subtype of the most common type of lymphoma, called non-Hodgkin’s lymphoma. It tends to grow slowly but often returns after treatment. The most common first symptom is a swollen lymph node.

This article examines the symptoms, treatment options, and outlook associated with follicular lymphoma.

Facts about follicular lymphoma

  • About 15,000 people develop follicular lymphoma in the United States each year.
  • The average age at diagnosis is about 60 years.
  • Follicular lymphoma rarely occurs in children, but when it does, it occurs in males about 10 times more often than it does in females.
  • Follicular lymphoma is the second most common type of non-Hodgkin’s lymphoma, making up about 30% of cases.
  • Follicular lymphoma is the most common slow-growing lymphoma.
  • Researchers have linked exposure to certain pesticides and herbicides with follicular lymphoma.
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Follicular lymphoma doesn’t tend to cause symptoms in the early stages, and it often grows slowly. Symptoms can vary among people depending on factors such as where the cancer began and the extent of the cancer.

Symptoms tend to follow a relapsing and remitting course, meaning that they flare up and go through periods of remission where they ease.

The most common first symptom is one or more swollen lymph nodes. Swollen lymph nodes feel like hard lumps under your skin. The swelling in the lymph node may come and go for years before you get a diagnosis.

Swollen lymph nodes also have many other causes that aren’t cancer.

Symptoms of spleen or bone marrow involvement

Follicular lymphoma can affect your spleen or bone marrow. Bone marrow involvement occurs in about 70% of people. When this happens, you may develop enlargement of your spleen and have low blood cell counts.

Low blood cell counts can cause symptoms such as:

Symptoms of follicular lymphoma B

About 20% of people with follicular lymphoma experience B symptoms. These symptoms play a role in predicting the outlook and staging of the cancer. B symptoms include:

As many as 30–40% of people with follicular lymphoma have a transformation to a more aggressive cancer called diffuse large B-cell lymphoma (DLBCL). B symptoms are more common in people with DLBCL.

Most cases of follicular lymphoma start in your lymph nodes. The most commonly involved lymph nodes are those in your:

  • armpits
  • neck
  • groin
  • thighs

You may also have swollen lymph nodes in your abdomen, but you can’t typically feel these lymph nodes.

A subtype of follicular lymphoma called primary gastrointestinal lymphoma starts in the gastrointestinal tract, usually in the first part of the small intestines. It tends to have a better outlook than follicular lymphoma in other locations.

Follicular lymphoma is rare in children, but when it develops, it primarily develops in the tonsils and lymph nodes of the head and neck. Many researchers consider follicular cancer that develops in children a separate type of lymphoma.

Follicular lymphoma often returns after treatment but may respond to additional treatment.

The main treatment options for follicular lymphoma include:

Follicular lymphoma tends to grow slowly and often has a good outlook, although the course of the condition can vary significantly among people. On average, people tend to live longer than 20 years after their diagnosis.

Some people may never develop symptoms, while others may develop life threatening complications and need frequent treatment.

Doctors often use 5-year relative survival rates to report survival statistics. A 5-year relative survival rate is a measure of how many people with the cancer are alive 5 years later compared with people without the cancer.

The 5-year relative survival rates for follicular lymphoma in the United States in 2012–2018 were:

Stage5-year relative survival rate
Localized97%
Regional91%
Distant87%
All stages90%

Prognostic factors

Healthcare professionals often use the Follicular Lymphoma International Prognostic Index to predict how well follicular lymphoma will respond to treatment. This index considers the following factors:

Prognostic factorGoodPoor
Age60 years or underover 60 years
Stage1 or 23 or 4
Hemoglobinover 120 grams per liter (g/L)under 120 g/L
Lactate dehydrogenase levelsnormalelevated
Number of affected lymph nodes4 or fewermore than 4

Your chances of dying from your cancer depend on how many risk factors you have:

Risk groupNumber of risk factors2-year survival rate
Low risk0 or 198%
Medium risk294%
High risk3 or more87%

Learn more about the grades and staging of follicular lymphoma.

Follicular lymphoma is a slow-growing cancer that develops in your lymph system. The first symptom is often swelling in a lymph node.

The outlook for follicular lymphoma varies among people, but it tends to be better than for most other types of lymphoma.

Healthcare professionals don’t usually consider follicular lymphoma curable since it often comes back after treatment. However, chemotherapy, radiation therapy, and other treatments can reduce your symptoms and potentially prolong your life by decades.