7 Common Follicular Lymphoma Symptoms You Should Know

Follicular lymphoma is a type of non-Hodgkin’s lymphoma that develops in the lymphatic system, affecting the white blood cells called B-lymphocytes. As one of the most common types of indolent (slow-growing) lymphomas, it typically affects adults and progresses gradually over time. Understanding the symptoms of follicular lymphoma is crucial for early detection and timely medical intervention.

The lymphatic system plays a vital role in your immune system, helping to fight infections and remove waste from your body. When follicular lymphoma develops, it causes abnormal B-cells to accumulate in the lymph nodes and other organs, leading to various symptoms that can significantly impact quality of life. While some people may experience noticeable signs early on, others might remain asymptomatic for extended periods.

In this comprehensive guide, we’ll explore the most common symptoms of follicular lymphoma, helping you recognize potential warning signs and understand when to seek medical attention.

1. Painless Swollen Lymph Nodes

The most characteristic and common symptom of follicular lymphoma is the presence of painless, enlarged lymph nodes. These swellings typically appear in areas where lymph nodes are concentrated:

• Neck region
• Armpits (axillae)
• Groin area
• Above the collarbone

Unlike lymph node swelling caused by infections, which are often tender and painful, the enlarged nodes associated with follicular lymphoma are usually painless and feel rubbery to the touch. They may appear as visible lumps under the skin and can range in size from a pea to several centimeters in diameter. These swollen nodes may come and go over months or even years, occasionally shrinking on their own before enlarging again. This waxing and waning pattern is relatively unique to follicular lymphoma and can sometimes delay diagnosis as people may dismiss the symptom when the swelling temporarily resolves.

The enlarged lymph nodes typically feel firm and moveable under the skin, and they don’t usually cause redness or warmth in the surrounding area. If you notice persistent lymph node swelling lasting more than two weeks, especially without accompanying signs of infection like fever or sore throat, it’s important to consult a healthcare provider for proper evaluation.

2. Persistent Fatigue and Weakness

Chronic fatigue is a prevalent symptom experienced by many people with follicular lymphoma. This isn’t the typical tiredness that resolves after a good night’s sleep; rather, it’s a profound, persistent exhaustion that interferes with daily activities and doesn’t improve with rest.

The fatigue associated with follicular lymphoma can manifest in several ways:

• Overwhelming exhaustion that makes routine tasks feel difficult
• Lack of energy even after adequate sleep
• Mental fog and difficulty concentrating
• Reduced stamina and exercise tolerance
• Needing frequent rest periods throughout the day

This fatigue occurs because the lymphoma cells interfere with the body’s normal immune function and may affect the production of healthy blood cells in the bone marrow. The body also expends considerable energy trying to fight the abnormal cells, contributing to the overwhelming sense of tiredness. Additionally, the release of certain chemicals called cytokines by the lymphoma cells can contribute to fatigue and general malaise.

Many patients report that this fatigue significantly impacts their quality of life, affecting their ability to work, exercise, and participate in social activities. It’s important to distinguish this pathological fatigue from normal tiredness, as it represents a significant symptom that warrants medical attention.

3. Unexplained Weight Loss

Unintentional weight loss is considered a significant “B symptom” in lymphoma diagnosis. This refers to losing more than 10% of your body weight over a six-month period without deliberately trying to lose weight through diet or exercise changes.

The weight loss associated with follicular lymphoma happens for several reasons:

• Increased metabolic rate as the body fights the disease
• Loss of appetite (anorexia)
• Early satiety (feeling full quickly after eating small amounts)
• Changes in taste and smell that make food less appealing
• Energy consumption by rapidly dividing cancer cells

For example, a person weighing 150 pounds (68 kg) who loses 15 pounds (6.8 kg) or more within six months without trying would meet this criterion. This type of weight loss is particularly concerning because it indicates that the disease is having a systemic effect on the body’s metabolism and overall function.

It’s important to track your weight and notify your healthcare provider if you experience significant, unexplained weight loss, as this can be an indicator of disease activity and may influence treatment decisions. Even if you’re not actively monitoring your weight, you might notice that your clothes fit more loosely or that others comment on your weight loss.

4. Night Sweats

Night sweats are another classic “B symptom” of follicular lymphoma and can be particularly distressing for patients. These aren’t mild perspiration or warmth from too many blankets; they’re drenching sweats that can soak through nightclothes and bedding, often requiring changes of clothing or sheets during the night.

Characteristics of lymphoma-related night sweats include:

• Profuse sweating that soaks sleepwear and bed linens
• Occurring specifically during sleep rather than throughout the day
• Happening repeatedly over weeks or months
• Not related to room temperature or excessive blankets
• Often accompanied by chills or feeling cold afterward

Night sweats in follicular lymphoma are thought to result from the body’s immune response to the lymphoma cells and the release of certain chemicals called cytokines. These substances can affect the body’s temperature regulation system, leading to episodes of intense sweating during sleep.

The severity of night sweats can vary from person to person and may fluctuate over time. Some people experience them nightly, while others have them intermittently. These episodes can significantly disrupt sleep quality, contributing to fatigue and reduced quality of life. If you’re experiencing regular night sweats that require changing clothes or bedding, especially when combined with other symptoms, it’s important to discuss this with your healthcare provider.

5. Fever Without Infection

Unexplained, recurrent fevers represent another important “B symptom” of follicular lymphoma. These fevers occur without an obvious source of infection and follow specific patterns that help distinguish them from common illnesses.

Follicular lymphoma-associated fevers typically present as:

• Temperature above 100.4°F (38°C)
• Recurring fevers without identifiable infection
• Fever episodes that may come and go over weeks or months
• Low-grade fevers that persist for extended periods
• Fever not responding to typical fever-reducing measures

These fevers occur as part of the body’s immune response to the presence of lymphoma cells. The lymphoma cells trigger the release of inflammatory substances called pyrogens, which signal the brain to raise the body’s temperature set point. Unlike fevers caused by bacterial or viral infections, these fevers won’t respond to antibiotics and may not fully resolve with standard fever-reducing medications.

Some patients experience what’s called “Pel-Ebstein fever,” a pattern of fever that recurs in cycles, with fever periods lasting several days followed by fever-free intervals. However, this pattern is relatively rare. More commonly, people experience intermittent low-grade fevers that come and go without a clear pattern.

If you have recurring fevers without an obvious cause like a cold, flu, or other infection, especially when accompanied by other symptoms on this list, it’s essential to seek medical evaluation.

6. Abdominal Swelling or Discomfort

Follicular lymphoma can affect lymph nodes and lymphoid tissue within the abdomen, leading to various digestive and abdominal symptoms. This occurs when the disease involves the spleen, liver, or lymph nodes in the abdominal cavity.

Abdominal symptoms may include:

• Visible swelling or bloating of the abdomen
• Feeling of fullness or pressure in the belly
• Discomfort or pain in the upper left abdomen (from spleen enlargement)
• Early satiety (feeling full after eating small amounts)
• Indigestion or changes in bowel habits
• Visible or palpable mass in the abdomen

Spleen enlargement (splenomegaly) is particularly common in follicular lymphoma, occurring in approximately 30-40% of patients at diagnosis. The spleen is located in the upper left portion of the abdomen, and when enlarged, it may be felt as a mass below the left rib cage. An enlarged spleen can cause a sense of fullness, discomfort, or pain in that area, especially after eating.

Similarly, liver enlargement (hepatomegaly) can occur when lymphoma cells infiltrate the liver, causing abdominal swelling and discomfort in the upper right abdomen. Enlarged abdominal lymph nodes can create pressure on surrounding organs, blood vessels, or nerves, leading to various symptoms including pain, digestive issues, or changes in bowel or bladder function.

If you experience persistent abdominal swelling, discomfort, or changes in how your abdomen feels, particularly when combined with other symptoms, it’s important to have this evaluated by a healthcare professional.

7. Shortness of Breath and Chest Discomfort

When follicular lymphoma affects lymph nodes in the chest (mediastinal lymph nodes) or involves the lungs, respiratory symptoms can develop. While less common as an initial presenting symptom, chest involvement can cause significant discomfort and functional impairment.

Respiratory symptoms associated with follicular lymphoma include:

• Shortness of breath (dyspnea), especially with physical activity
• Persistent cough without other signs of respiratory infection
• Chest pressure or discomfort
• Difficulty taking deep breaths
• Wheezing or noisy breathing
• Reduced exercise tolerance

These symptoms occur when enlarged lymph nodes in the chest cavity press against the airways, lungs, or major blood vessels. The pressure can restrict airflow, reduce lung capacity, or impede blood flow through the vessels in the chest. In some cases, lymphoma cells may directly infiltrate the lung tissue itself, causing inflammation and respiratory symptoms.

Enlarged mediastinal (chest) lymph nodes can also press on the superior vena cava, the large vein that returns blood from the upper body to the heart. This can lead to a condition called superior vena cava syndrome, which causes swelling of the face, neck, and arms, along with difficulty breathing. While this is a less common presentation, it represents a medical emergency requiring immediate attention.

Any new or persistent respiratory symptoms, especially when accompanied by other signs of lymphoma, should be evaluated promptly by a healthcare provider. Chest X-rays or CT scans may be necessary to assess for lymph node enlargement or lung involvement.

What Causes Follicular Lymphoma?

The exact cause of follicular lymphoma remains unclear, but researchers have identified several factors and mechanisms involved in its development. Understanding these causes can help contextualize the disease, though it’s important to note that many people with follicular lymphoma have no identifiable risk factors.

Genetic Mutations: The hallmark of follicular lymphoma is a specific genetic abnormality called a translocation between chromosomes 14 and 18, written as t(14;18). This translocation occurs in approximately 85-90% of follicular lymphoma cases. This genetic change causes the overproduction of a protein called BCL-2, which prevents abnormal B-cells from dying as they normally should, allowing them to accumulate and form tumors. This mutation is acquired during a person’s lifetime and is not inherited from parents.

Age: Follicular lymphoma primarily affects older adults, with the median age at diagnosis being around 60-65 years. The disease is rare in children and young adults. The risk increases progressively with age, suggesting that accumulated genetic changes over time may contribute to disease development.

Immune System Dysfunction: People with weakened immune systems have an increased risk of developing lymphomas, including follicular lymphoma. This includes individuals with autoimmune diseases, those taking immunosuppressive medications (such as after organ transplantation), and people with HIV/AIDS.

Environmental Exposures: Some studies have suggested links between certain environmental exposures and increased lymphoma risk, including:

• Occupational exposure to certain pesticides and herbicides
• Exposure to certain organic solvents
• Hair dye use (though evidence is inconsistent)

Family History: While follicular lymphoma itself is not inherited, having a first-degree relative (parent, sibling, or child) with lymphoma or another blood cancer slightly increases your risk. This suggests that genetic susceptibility factors may play a role.

Gender: Follicular lymphoma shows a slight predominance in women compared to men, though the reasons for this gender difference are not well understood.

It’s crucial to understand that having one or more risk factors doesn’t mean you will develop follicular lymphoma, and many people diagnosed with the disease have no known risk factors. The disease appears to result from a complex interaction of genetic, environmental, and immunological factors.

Frequently Asked Questions

Is follicular lymphoma a type of cancer?

Yes, follicular lymphoma is a type of blood cancer that falls under the category of non-Hodgkin’s lymphoma. It develops from B-lymphocytes (a type of white blood cell) and is generally considered an indolent or slow-growing cancer.

How quickly do follicular lymphoma symptoms develop?

Follicular lymphoma is typically slow-growing, so symptoms often develop gradually over months or even years. Some people may have the disease for a long time before symptoms appear, while others may notice symptoms relatively early. The pace of symptom development varies considerably from person to person.

Can follicular lymphoma symptoms come and go?

Yes, one characteristic feature of follicular lymphoma is that symptoms, particularly swollen lymph nodes, can wax and wane. Lymph nodes may enlarge, then shrink on their own, then enlarge again. This fluctuating pattern can sometimes delay diagnosis as people may assume the problem has resolved when symptoms temporarily improve.

Are follicular lymphoma symptoms different from other types of lymphoma?

Many symptoms overlap with other lymphomas, including painless swollen lymph nodes, fatigue, night sweats, and fever. However, follicular lymphoma’s slow-growing nature and the tendency for symptoms to fluctuate can distinguish it from more aggressive lymphomas. Definitive diagnosis requires biopsy and specialized testing.

When should I see a doctor about potential follicular lymphoma symptoms?

You should consult a healthcare provider if you experience persistent swollen lymph nodes lasting more than two weeks, unexplained weight loss, recurring night sweats, persistent fevers without infection, or unusual fatigue that doesn’t improve with rest. While these symptoms can have many causes, they warrant medical evaluation to determine the underlying cause.

Can you have follicular lymphoma without symptoms?

Yes, some people with follicular lymphoma have no noticeable symptoms at diagnosis. The disease may be discovered incidentally during medical tests or examinations performed for unrelated reasons. This is sometimes referred to as asymptomatic or “watch and wait” stage disease.

Do all people with follicular lymphoma experience the “B symptoms”?

No, not everyone with follicular lymphoma experiences B symptoms (fever, night sweats, and weight loss). In fact, many patients with follicular lymphoma have what’s called “stage A” disease, meaning they don’t have B symptoms. The presence of B symptoms may indicate more active disease and can influence treatment decisions.

Is follicular lymphoma curable?

Follicular lymphoma is generally considered treatable but not typically curable with current standard therapies. However, many people live for many years with the disease, and some may experience long periods of remission. Treatment approaches depend on the stage and symptoms of the disease. Always consult with your healthcare provider about treatment options appropriate for your specific situation.

Can lifestyle changes reduce follicular lymphoma symptoms?

While lifestyle changes cannot cure follicular lymphoma, maintaining good overall health through balanced nutrition, regular physical activity (as tolerated), adequate sleep, and stress management may help improve energy levels and quality of life. However, any symptom management should be discussed with your healthcare team as part of a comprehensive care plan.

References:

• American Cancer Society – Non-Hodgkin Lymphoma
• Mayo Clinic – Follicular Lymphoma
• Lymphoma Research Foundation – Follicular Lymphoma
• National Cancer Institute – Lymphoma
• NHS – Non-Hodgkin Lymphoma