Follicular Lymphoma: Symptoms, Diagnosis, Treatment


Lymphoma is the most common blood cancer. It can be further divided into two types: Hodgkin lymphoma and non-Hodgkin lymphoma. Follicular lymphoma (FL) is a cancer that involves certain types of white blood cells known as lymphocytes. Typically, it is considered a slow-growing or indolent form of non-Hodgkin lymphoma (NHL) that arises from B-lymphocytes, making it a B-cell lymphoma.

According to the statistics, about 20% people with lymphomas in the United States are diagnosed with a follicular lymphoma. It seldom affects young people and is more commonly found among those who are about 60 years old. It’s slightly more common in women than in men. Although it can’t usually be cured, most affected people can live with it and can live longer than they expect. Causes are still unknown, but it is said that you’ll be put at a higher risk of getting the disease if you have lupus, celiac disease, HIV or rheumatoid arthritis.


In some cases, affected people may not have any symptoms at all. But sometimes, people with follicular lymphoma do experience some symptoms. In most cases, they may experience painless swellings in the lymph nodes (esp. in the neck and armpits). Moreover, they may suffer from symptoms such as fatigue, infections, unexplained weight loss, chest pain, cough, abdominal pain and distention, shortness of breath, skin lesions, palpable thyroid mass, fevers (>100.4°F°) or drenching night sweats. In advanced stages, other symptoms can also occur. It is reported that people with follicular lymphoma are more likely to develop abdominal tumors which can obstruct normal digestion and urination.


Based on the Ann-Arbor classification(Ann Arbor, Michigan, where the Committee on Hodgkin’s Disease Staging Classification met in 1971), follicular lymphoma can be described as four stages.

Stage 1

In this stage, a single lymph node region, or of a single/localized extranodal site is involved.

Stage 2

In this stage, two or more lymph node regions on the same side of the diaphragm, or an extranodal site or organ is involved.

Stage 3

In stage 3, two or more lymph node regions on both sides of the diaphragm, or localized extranodal foci and affected lymph nodes on both sides of the diaphragm are involved.

Stage 4

In stage 4, affected people may be noticed diffuse or disseminated involvement of one or more extralymphatic organs, with or without lymph node involvement.


Since follicular lymphoma is a cancer with subtle symptoms, it makes it even harder for doctors to make a precise diagnosis. Usually, a patient is diagnosed in the later stages of the disease. Like diagnosis of most diseases, the very first step for diagnosing someone with follicular lymphoma is to order a complete physical exam and to ask the patient about his/her medical history. Next, the doctor may order some tests to look for hepatosplenomegaly since half of the affected people have hepatosplenomegaly.

Generally, the most efficient way to make a diagnosis is do a biopsy. However, the biopsy alone is not enough. To get a precise diagnosis, the doctors may also need to order other tests to evaluate the type, extent, and stage of the disease.

Possible tests may include:

Laboratory tests

Complete blood counts (CBC)

Blood smear or manual differential, blood chemistry

Flow cytometry

Bone marrow cytology and bone marrow histology

Quantitative analysis of immunoglobulins

Pathologic tests

Morphologic evaluation


Imaging tests

Positron emission tomography in higher grades of the malignant process

CT scan of the neck/abdomen/thorax/pelvis


Treatment may be slightly different, depending on the severity and stages of the disease. Possible treatment options available for patients are listed as follows:

Watchful waiting

This method is usually applied to those who are still in the early stage of the disease and just have a few symptoms. You will not receive any treatment yet, and the doctor may keep an eye on your condition.


It is known to us that this method will use drugs to kill cancer cells in your body. It’s worth mentioning that it is usually combined with other types of treatments.

Radiation therapy

It is reserved for those who are still in the early stage of the disease. To conduct this therapy, high-energy beams are used to kill cancer cells. It is reported that it can even sometimes cure this type of cancer. In more advanced stages, other therapies are usually involved in the treating process.


During the process, doctors will use the medicine yttrium-90 ibritumomab tiuxetan (Zevalin) to deliver radiation to cancer cells.

Monoclonal antibodies

Monoclonal antibodies are medicines that help your immune cells fight against the cancer. Basically, doctors may suggest Rituximab (Rituxan) which is commonly used to treat follicular lymphoma. It’s typically given as an IV infusion at your doctor’s office and is often used along with chemotherapy.

Stem cell transplant

In some cases, especially if your cancer comes back, it might be helpful to conduct a stem cell transplant surgery. It can be further divided into two basic types: autologous transplant (from your own stem cells) and allogeneic transplant (from the donor). During the process, doctors will infuse healthy stem cells into your body to replace diseased bone marrow.


The Follicular Lymphoma International Prognostic Index (FLIPI) is used to plan the treatment and predict the prognosis.

Generally, patients under 60 years old, in stage 1 or 2, with hemoglobin 120 g/L or higher, with 4 or less affected lymph node areas, and a normal lactate dehydrogenase (LDH) level have good prognosis.

Patients older than 60, in stage 3 or 4, with hemoglobin less than 120 g/L, with more than 4 affected lymph node areas, and a higher than normal lactate dehydrogenase (LDH) level have poor prognosis.

Related Posts

How to Treat Follicular Lymphoma?

What Is Follicular Lymphoma?

What Is Non-Hodgkin’s Lymphoma?

Non-Hodgkin’s Lymphoma-Symptoms

Keywords: follicular lymphoma, non-Hodgkin’s lymphoma

* The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.