Follicular lymphoma is a type of cancer that starts in the white blood cells of your body. There are two main forms of lymphoma: Hodgkin and non-Hodgkin. Follicular lymphoma is a non-Hodgkin lymphoma.

This type of lymphoma typically grows slowly, which doctors call “indolent.”

Read on to learn more about the symptoms of follicular lymphoma and what treatment options are available.

Non-Hodgkin lymphoma is one of the most common cancers in the United States. More than 72,000 people are diagnosed with a form of it each year.

About one in every five lymphomas in the United States is a follicular lymphoma.

Follicular lymphoma rarely affects young people. The average age for someone with this type of cancer is about 60.

Symptoms of follicular lymphoma may include:

  • enlarged lymph nodes in the neck, underarms, belly, or groin
  • fatigue
  • shortness of breath
  • fevers or night sweats
  • weight loss
  • infections

Some people with follicular lymphoma don’t have any symptoms at all.

To diagnose follicular lymphoma, your doctor may perform the following tests:

  • Biopsy. A biopsy is done to examine tissue under a microscope and determine if it’s cancerous.
  • Blood test. You may need a test to check your blood cell counts.
  • Imaging scan. Your doctor may suggest you have an imaging scan to see the lymphoma in your body and to plan your treatment. Computed tomography (CT) and positron emission tomography (PET) scans are commonly used.

Several treatment options are available for people with follicular lymphoma. Your doctor will decide which therapy is right for you based on your type of cancer and how advanced it is.

Watchful waiting

If you’re diagnosed early and have only a few symptoms, your doctor might suggest that you watch and wait. This means your healthcare provider will keep a watchful eye on your condition, but you won’t receive any treatment yet.

Radiation

Radiation uses high-energy beams to destroy cancer cells. It’s often given to people with early-stage follicular lymphoma. In some cases, radiation alone may be able to cure this type of cancer. You may need radiation along with other therapies if your cancer is more advanced.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells in your body. It’s sometimes given to people with follicular lymphoma, and is frequently combined with other treatments.

Monoclonal antibodies

Monoclonal antibodies are medicines that target particular markers on tumors and help your immune cells fight the cancer. Rituximab (Rituxan) is a monoclonal antibody that’s commonly used to treat follicular lymphoma. It’s typically given as an IV infusion at your doctor’s office and is often used in combination with chemotherapy.

Common combinations include:

  • r-bendamustine (rituximab and bendamustine)
  • R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone)
  • R-CVP (rituximab, cyclophosphamide, vincristine, and prednisone)

Radioimmunotherapy

Radioimmunotherapy involves using the medicine yttrium-90 ibritumomab tiuxetan (Zevalin) to deliver radiation to cancer cells.

Stem cell transplant

A stem cell transplant is sometimes used for follicular lymphoma, especially if your cancer comes back. This procedure involves infusing healthy stem cells into your body to replace diseased bone marrow.

There are two kinds of stem cell transplants:

  • Autologous transplant. This procedure uses your own stem cells to treat your cancer.
  • Allogeneic transplant. This procedure uses healthy stem cells from a donor.

When a slow-growing lymphoma, such as follicular lymphoma, turns into a more fast-growing form, it’s known as transformed lymphoma. Transformed lymphoma is usually more aggressive and may require more rigorous treatment.

Some follicular lymphomas can turn into a fast-growing type of lymphoma called diffuse large B-cell lymphoma.

After successful treatment, many people with follicular lymphoma will go into remission. Even though this remission can last for years, follicular lymphoma is considered a lifelong condition.

This cancer can come back, and sometimes, people who relapse don’t respond to treatment.

Treatments for follicular lymphoma are typically used to keep the disease under control rather than to cure the condition. This cancer can usually be successfully managed for many years.

Doctors have developed the Follicular Lymphoma International Prognostic Index (FLIPI) to help provide a prognosis for this type of cancer. This system helps categorize follicular lymphoma into three categories:

  • low risk
  • intermediate risk
  • high risk

Your risk is calculated based on your “prognostic factors,” which includes things like age, the stage of your cancer, and how many lymph nodes are affected.

The five-year survival rate for people with follicular lymphoma who are low risk (have no or only one poor prognostic factor) is about 91 percent. For those with intermediate risk (two poor prognostic factors), the five-year survival rate is 78 percent. If you’re high-risk (three or more poor prognostic factors), the five-year survival rate is 53 percent.

Survival rates can offer useful information, but they’re only estimations and can’t predict what will happen in your particular situation. Talk to your doctor about your specific outlook and which treatment plans are right for your situation.