/ Updated January 30th, 2026

All About Follicular Lymphoma: A Common Type of Non-Hodgkin Lymphoma

Creator: Dr. Jakub Svoboda
Published: 2020-11-07T11:54:10-05:00

: Dr. Ranjit Nair Written by: Dr. Jakub Svoboda
Penn Medicine

Details
Transcript
Save This Video

Characteristics of Follicular Lymphoma

Most common indolent (slow-growing) B-cell lymphoma
Cells divide very slowly
May grow so slowly that it doesn’t require treatment

There are more than 30 different types of non-Hodgkin lymphoma, but some are a lot more common than others. Follicular lymphoma is the most common type of indolent — or slow-growing — lymphoma, accounting for 20 to 30% of all non-Hodgkin lymphoma cases.

This type of non-Hodgkin lymphoma occurs when B lymphocytes (a type of white blood cell that fights infection) become abnormal. The abnormal cells usually build up in the lymph nodes, but can affect other areas of the body as well. "Follicular lymphoma is a somewhat confusing disease to many patients and general oncologists, because it's cancer arising from a B-cell lymphocyte, but it can be very, very indolent, which means that the cells are dividing very slowly," says Dr. Jakub Svoboda, a hematology specialist at Penn Medicine.

In very aggressive or high-grade types of non-Hodgkin lymphoma, like Burkitt lymphoma, a pathology report might show 90 or 100% of cells actively dividing. "But in follicular lymphoma we sometimes see numbers as low as 5 or 10%," says Dr. Svoboda. "That's an indication of how very slow growing these follicular lymphomas can be."

Diagnosis and Treatment

Because the cancer is so slow growing, it may initially be misdiagnosed as asymptomatic lymph node enlargement. There may be few or no symptoms, and patients may find out they have this disease by accident, when they go in for medical testing for another condition.

For example, a patient may develop kidney stones and have a CT scan because of severe back pain. The CT scan shows the kidney stones, but it also shows some 2 centimeter lymph nodes in the groin area. The patient is referred for a biopsy and finds out that he or she has cancer. "That's obviously a huge shock to them, because they pass the kidney stone and they're feeling totally normal, their blood work is normal," says Dr. Svoboda. But now they must deal with the diagnosis of follicular lymphoma.

Follicular lymphoma can be so slow-growing that patients may not need any treatment for the cancer at all. Instead, the doctor may prefer that patients schedule periodic visits for what they call watchful waiting or active observation. On a frequency determined by patient and doctor, the patient will come for regular exams to check that the cancer remains slow growing and isn't causing any new or troublesome symptoms.

"Follicular lymphoma is not considered curable, but many patients live with this disease and go on to die of something else completely," says Dr. Svoboda. In fact, even when follicular lymphoma is diagnosed at an advanced stage, the average survival is greater than twenty years.

There are, of course, exceptions, and some patients with follicular lymphoma will have disease that's difficult to manage. "There are all kinds of presentations and situations," says Dr. Svoboda. Symptoms, when they occur, can include anemia, fatigue, and a low platelet count. But these cases tend to be the exception, and when follicular lymphoma does require treatment, there are many options, and generally very good outcomes.

Learn more about SurvivorNet's rigorous medical review process.

Dr. Jakub Svoboda is a medical oncologist at Penn Medicine, and associate professor of medicine at the Hospital of the University of Pennsylvania. Read More