Burkitt's lymphoma

Burkitt's lymphoma or BL is one of the fastest growing lymphomas or lymphatic cancers. It is a kind of non-Hodgkin’s lymphoma where cancer develops from the B lymphocyte cells (B cells). It is also easier to treat than other types of lymphomas, particularly if caught early and has high survival and cure rates.

Definition & Facts

Denis Burkitt—a British surgeon—first noticed Burkitt's lymphoma among children in Africa in 1956. The medical world then named it after him. Burkitt saw that the disease affected children who had both malaria and the Epstein-Barr virus.

In America, Burkitt's lymphoma is rare; only 1,200 new cases occur annually. Over 59% of Burkitt’s lymphoma cases occur in people over the age of 40. BL affects people with weakened immune systems and thus is highly likely to develop in people living with HIV.

There are several types of Burkitt's lymphoma:

• Endemic (African) BL – It affects children between four and seven years indigenous to Africa. It is more prevalent among boys than girls.
• Sporadic (non-African) BL – It occurs in the rest of the world. It accounts for between 1% and 2% of cases globally. In Western Europe and the US, it accounts for 40% of lymphoma cases among children.
• Immunodeficiency associated Burkitt's lymphoma – It affects people with weakened immune system defenses. People on immunosuppressive drugs may also get the disease.

Symptoms & Complaints

For the other BL types, a bulky tumor may form in the bowel and cancer may spread to the bone marrow, spleen, liver, and even to the brain and cerebrospinal fluid. Other symptoms include:

• Swollen lymph nodes
• Nausea and vomiting
• Acute abdominal pain
• Severe bowel problems like bowel obstruction and intestinal bleeding
• Night sweats
• Fatigue
• Loss of appetite and unintentional weight loss
• Low blood counts if the bone marrow develops lymphoma
• Headaches, seizures and confusion in the event of lymphoma in the brain or spinal cord

Causes

BL is not inheritable nor contagious. Experts link the endemic (African) BL to the Epstein-Barr virus (EBV) but, in the other cancers, its connection is inconclusive. Studies show that since nearly nine out of ten adults in the western countries have come into contact with the Epstein-Barr virus, it does not appear to have a direct link to causing sporadic BL.

A vulnerable immune system system leaves an individual at risk of getting Burkitt’s lymphoma. People having an HIV infection are susceptible to BL. Other factors may predispose one to BL, like diabetes, chemotherapy, a family history of BL and organ transplant.

Diagnosis & Tests

Doctors typically perform biopsies on the involved tissue. A pathologist examines the tissues for specific proteins in the cell and also changes in the genes. Doctors may also conduct other tests to try and diagnose correctly. Such tests include:

• Complete blood count tests
• Liver and kidney tests
• CT scan of the chest, abdomen, and pelvic region
• Examination of the cerebrospinal fluid
• Bone marrow biopsy
• HIV tests
• Chest X-rays
• PET scan

Burkitt's lymphoma is diagnosed in four stages which indicates the level of metastasis.

• Stage I - Only one site. The lymphoma affects only a group of lymph nodes or an extranodal site (outside the lymphatic system)
• Stage II – At this point, lymphoma affects only one side of the diaphragm and in more groups of lymphatic nodes and also an extranodal site.
• Stage III – The lymphoma affects both sides of the diaphragm covering more lymphatic nodes and extranodal sites.
• Stage IV – The disease has spread to the bone marrow or in the central nervous system—the brain or spinal cord or both.

Treatment & Therapy

After doctors determine what stage a person's cancer is in, they may term it favorable. It means that one may need less treatment. Doctors treat Burkitt's lymphoma through chemotherapy. It does not matter the extent of its spread.

• Intravenous chemotherapy. Doctors administer drugs through a drip into the vein. It is the easiest way to kill cancerous cells. This treatment has its drawbacks as patients will have to receive inpatient treatment because the treatment takes several days. One would require constant monitoring and tests to check liver and kidney health plus blood cell count. A person needs a lot of fluid which is administered to the kidneys through a drip to keep them working well.

• Intrathecal chemotherapy. If cancer spreads to the central nervous system, intrathecal chemotherapy is a sure way of getting drugs directly to the affected areas. The doctor gives chemotherapy directly into the cerebrospinal fluid. Doctors administer a few drugs this way such as methotrexate. Doctors may use the following medications in combination: cyclophosphamide, cytarabine, doxorubicin, etoposide, and vincristine

Other treatment options may include radiotherapy where X-rays kills cancerous cells and stem cell transplants where after killing the cancerous cells, new cells, your own or from a donor, are introduced into your body.

Survival rates for those with this cancer vary according to various factors. Age, extent of spread and the strength of the immune system play a huge role. If a person develops the disease and it is at a particular area alone, the survival rate is at 90%. For people over the age of 40, their rates of survival are much lower than children and adolescents.

Prevention & Prophylaxis