Most people who develop follicular lymphoma are over aged 50, but the disease can occur at any age.

The symptoms of follicular lymphoma are usually subtle and may go undetected for years. A painless, enlarged lymph node or nodes may be your first sign of the tumor. You may feel healthy and energetic at the time of diagnosis; however, some people have unexplained weight loss, fever, night sweats, and severe itching.

A full physical examination may identify any swollen lymph nodes and assess your general health. Swollen lymph nodes will be biopsied to identify the cause of the swelling. Follicular lymphoma cells have particular features that distinguish them from other types of cancer.

Once follicular lymphoma is diagnosed, your doctor will determine the stage of the tumor by assessing how many nodes or other sites are affected. Early stage disease is generally localized to one area and does not cause symptoms, while advanced-stage disease has spread further in the body and may cause symptoms. Other risk factors—age, anemia, levels of other molecules in the blood—can predict behavior of the disease and may help your doctor determine the best treatment.

Your treatment may begin at diagnosis or may be delayed while the hematologist/oncologist evaluates how quickly the tumor is growing. Many people with early stage disease will receive radiation therapy, or radiotherapy, to the affected lymph node. Some doctors prescribe a chemotherapy regimen for early stage disease. Alternatively, your doctor may choose to monitor how the tumor grows, also known as a “watch-and-wait” approach.

The majority of people with follicular lymphoma have advanced-stage disease when they are diagnosed. There are several effective treatments for advanced-stage follicular lymphoma that allow most patients with advanced-stage disease to live for a decade or more.

Patients who are not experiencing symptoms from the tumor may be monitored with a “watch-and-wait” approach, which has been shown to be a safe strategy in patients with advanced-stage disease.

When the tumor progresses and becomes symptomatic, patients are likely to receive a regimen of chemotherapy in combination with rituximab, an antibody that binds to B-cells, including follicular lymphoma cells.

Even when follicular lymphoma responds to treatment, it recurs in many people. Some may be prescribed “maintenance therapy,” which is a long-term use of a therapy, such as the antibody rituximab, to prevent tumor growth. Maintenance therapy can lengthen the time until the tumor recurs, but it may be associated with side effects.

You and your doctor should continue to monitor for the disease in the years after treatment by examining lymph nodes and targeted organs, reviewing any symptoms associated with the disease, and having regular bloodwork done.