Follicular Lymphoma

Follicular lymphoma is a type of slow-growing blood cancer that affects the lymph nodes, bone marrow and sometimes other organs. It develops when healthy, infection-fighting B cells turn into cancer cells that gather in clumps called follicles. This cancer is the most common type of slow-growing lymphoma and the second most common type of non-Hodgkin lymphoma. While many respond well to treatment and can live with the disease for years, follicular lymphoma usually cannot be cured and often comes back after therapy.^{1 2 5 6}

Across the word, follicular lymphoma affects over a million people.⁶ While there is no way to currently prevent follicular lymphoma, there are some common risk factors. These risk factors include race, age, and family history. Follicular lymphoma is most common in those who are white, 60 years old or older, and those with a family history of lymphoma.^{1 2}

Healthcare providers use grades and stages to determine the severity of the cancer and create a tailored treatment plan. Non-Hodgkin lymphoma is classified into two grades to determine how quickly it will spread, low grade and high grade. Since follicular lymphoma is typically slow growing, it is a low-grade lymphoma. For follicular lymphoma, doctors sometimes add additional grades: grade 1, grade 2, grade 3 (dividing into 3A and 3B). In this case, grades 1, 2 and 3A are considered slow-growing, with 3B being faster-growing.⁵

The stages help to identify where in the body and how many places the lymphoma is present in. The stages range from 1 to 4:

Stage I – One lymph node or one single area in an organ outside of the lymph nodes is affected

Stage II – Two or more lymph node regions on the same side of the diaphragm are affected

Stage III – Lymph node regions on both side of the diaphragm are affected. Another site outside of the lymphatic system may also be affected

Stage IV – Follicular lymphoma has spread outside of the lymph nodes^{1 2}

Symptoms of follicular lymphoma often don’t show in the early stages, so most people are Stage III or IV at the time of their diagnosis.²

Like other types of lymphoma, the first step to diagnose follicular lymphoma is through a physical exam. In the exam, doctors check for swollen lymph nodes in the neck, underarms or groin, along with a swollen liver or spleen.¹ The only way to confirm diagnosis, however, is through a biopsy. In the biopsy your doctor will remove part, or all the swollen lymph node and will send to a laboratory specialist to examine for cancer cells.5 After diagnosis is confirmed, your doctor may perform blood tests, PET scans, and CT scans to help determine which stage the cancer is in.²

While your personal prognosis can depend on factors like age, overall health, stage, and biopsy results, the general prognosis for follicular lymphoma is positive.¹ About 50% of people diagnosed with follicular lymphoma are alive 20 years later and about 90% of people are alive 5 years after diagnosis. While reading these statistics, it’s important to keep in mind that most people are diagnosed with follicular lymphoma over the age of 50, meaning many people die of causes completely unrelated to the cancer.²

Despite the slow-growing nature and positive overall prognosis of follicular lymphoma, it is important to actively monitor how the disease impacts you over time. Treatment needs may vary, more aggressive diseases may develop, and chances of cancer progression can increase each year.²

Researchers are continuously investigating potential new and more effective treatments. For guidance on the best treatment options for you—and to determine if you may qualify for a clinical trial—please speak with your healthcare provider.