Follicular Lymphoma: Causes, Symptoms, and Treatment
Medically reviewed by Achuta Uppu, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Follicular Lymphoma?
A medical oncologist, a doctor who treats cancer, or a hematologist, a doctor who treats blood cancers, usually oversees care for follicular lymphoma. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is follicular lymphoma?
Follicular lymphoma is the most common type of indolent non-Hodgkin lymphoma. Non-Hodgkin lymphoma is a cancer that starts in the lymph system. The lymph system is made up of tissues and organs that help protect the body from infection. Indolent means slow-growing.
Follicular lymphoma is a very slow-growing cancer that begins in B lymphocytes, a type of white blood cell. It affects the lymph nodes and may spread to the bone marrow or spleen. Lymph nodes are small, bean-shaped glands that help fight infection.
It is the second most common type of non-Hodgkin lymphoma overall. Sometimes follicular lymphoma can become a more aggressive type of lymphoma, such as diffuse large B-cell lymphoma.
Symptoms
Indolent lymphoma tends to grow and spread slowly and has few signs and symptoms. The most common sign is painless swelling of the lymph nodes that can come and go. It often involves nodes in the underarm, neck, upper leg, and groin.
Only 20% of people with follicular lymphoma have B symptoms, which are night sweats, fever, and weight loss.
Other signs of non-Hodgkin lymphoma in general can include:
- Fever and chills.
- Weight loss.
- Fatigue, which means feeling very tired.
- A swollen belly.
- Severe or frequent infections.
- Easy bruising or bleeding.
Having one or more of these symptoms does not mean you have lymphoma. Many are more likely to be caused by other conditions, such as an infection.
Causes and who gets it
Older age, being male, and having a weakened immune system can increase the risk of non-Hodgkin lymphoma. Follicular lymphoma is mostly a disease of older adults. Most people with follicular lymphoma are age 50 years and older when they are diagnosed. It is relatively uncommon in children.
Exposure to pesticides and herbicides has been established as a risk factor.
Most cases involve a gene change that leads to too much of a protein called B-cell lymphoma 2, or BCL2.
How doctors diagnose it
Doctors start with your history, a physical exam, and blood tests. Scans such as CT, MRI, and PET/CT are also used.
A lymph node biopsy is crucial for diagnosing follicular lymphoma. In a biopsy, a doctor removes all or part of a lymph node. A pathologist, a doctor who studies tissue, looks at it under a microscope to check for cancer cells.
A bone marrow biopsy should be done before treatment starts to confirm the stage. Follicular lymphoma is graded from 1 to 3, from low grade to high grade.
Treatment
Treatment depends on the stage of the disease. Treatment should be planned by a team of health care providers who are experts in treating lymphomas.
People with no symptoms are mainly watched closely without any treatment. This is called watchful waiting. It means closely checking your condition without treatment until signs or symptoms appear or change.
For stage I disease in grades 1, 2, and 3A, radiation therapy is preferred. Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells.
For advanced disease that causes symptoms, antibody medicines are combined with chemotherapy. Rituximab and obinutuzumab are two of them. Chemotherapy uses drugs to stop the growth of cancer cells.
Treatment may also be given in a clinical trial of a new antibody therapy, a new chemotherapy plan, or a stem cell transplant.
After remission, follow-up visits are planned every 3 months during the first year and then every 3 to 6 months.
When to see a doctor
Check with your doctor if you have any of the following:
- Swelling in the lymph nodes in the neck, underarm, groin, or stomach.
- Fever for no known reason.
- Drenching night sweats.
- Weight loss for no known reason.
- Feeling very tired.
Swelling of the head, arms, and upper chest can be a sign of SVC syndrome. The skin there may turn bluish-red. SVC syndrome can be life-threatening and must be treated right away.
Call 911 or go to the emergency room if you have trouble breathing, swelling of the head, arms, and upper chest, chest pain or discomfort lasting two minutes or more, fainting, or a sudden change in mental state.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. A direct primary care doctor can check swollen lymph nodes, order first tests, and refer you to a cancer specialist. They can also help coordinate your care and follow-up visits.
Common questions
Is follicular lymphoma a cancer?
Yes, follicular lymphoma is a cancer. It is a type of non-Hodgkin lymphoma that begins in B lymphocytes, a type of white blood cell.
Does follicular lymphoma grow fast?
No, it is a very slow-growing type of non-Hodgkin lymphoma. Sometimes it can become a more aggressive type of lymphoma.
Does follicular lymphoma need treatment right away?
Not always. People with no symptoms are mainly watched closely without treatment. Treatment of stage II, III, and IV disease mainly focuses on improving quality of life and easing symptoms.
Who gets follicular lymphoma?
Follicular lymphoma mostly affects older adults. Most people with follicular lymphoma are age 50 years and older when they are diagnosed. It is relatively uncommon in children.
Sources
- National Cancer Institute - Non-Hodgkin Lymphoma Treatment (PDQ), Patient Version
- NCBI Bookshelf (StatPearls) - Follicular Lymphoma
- American Cancer Society - Signs and Symptoms of Non-Hodgkin Lymphoma
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
