Burkitt’s lymphoma is a type of B-cell lymphoma.
In 1956 a British surgeon called Dennis Burkitt was working in equatorial Africa. He described an unusual type of lymphoma, which was very common in children in that region. This became known as Burkitt’s lymphoma.
Burkitt’s lymphoma is a type of B-cell lymphoma.
In 1956 a British surgeon called Dennis Burkitt was working in equatorial Africa. He described an unusual type of lymphoma, which was very common in children in that region. This became known as Burkitt’s lymphoma.
Later research showed that B-lymphocytes in these children had been infected with the Epstein-Barr virus (or E-B virus). Epstein-Barr virus infections are known as glandular fever or infectious mononucleosis: they are common and usually cause no problems, but in central Africa many of the children had chronic malaria infections, which reduced their resistance to the virus. In some cases this allowed the virus to change the infected B-lymphocytes into cancerous cells, leading to the development of the lymphoma. This is known as classical African or endemic Burkitt’s lymphoma.
In one type of non-Hodgkin’s lymphoma the tumour cells have very similar appearances under the microscope to those of classical African or endemic Burkitt’s lymphoma. This rare condition is still called Burkitt’s lymphoma but is known as the non-African or sporadic type.
It seems that in this condition, once again, the Epstein-Barr virus infection can develop because the patient has reduced immunity. The Epstein-Barr virus is able to survive and ‘transforms’ the normal B-lymphocytes into cancerous cells. However, in the Burkitt’s lymphoma seen in the UK, the way normal B-lymphocytes change to cancer cells is less clear and not all cases occur in people who have been in contact with the Epstein-Barr virus.
Diagram showing the lymphatic system
Signs and symptoms
In the Western world the most common symptom is an abdominal swelling starting in the bowel. Burkitt’s lymphoma may also affect other organs such as the eye, the ovaries, kidneys, and glandular tissue such as the breast, thyroid or tonsil. The classical African or endemic type of Burkitt’s lymphoma usually affects the jawbone. It can spread to the nervous system, damaging the nerves and causing possible weakness or paralysis. It may also affect the lymph nodes or bone marrow. Some people have loss of appetite and tiredness.
Other symptoms, which are known as B symptoms, include sweating at night, unexplained high temperatures, and weight loss.
How it is diagnosed
A diagnosis is made by removing an enlarged lymph node, or part of it, and examining the cells under a microscope. This is known as a biopsy and you will be referred to a surgeon for this procedure. It is a very small operation and may be done under local or general anaesthetic. Biopsies may also be taken from other body tissues to find out whether the lymphoma has spread.
Additional tests, including blood tests, x-rays, scans, lumbar puncture and bone marrow samples, are then used to get more information about the type of lymphoma and how far it has spread in the body. This information is used to help decide which treatment is most appropriate.
Staging
The ‘stage’ of NHL describes how many groups of lymph nodes are affected, where they are in the body, and whether other organs such as the bone marrow or liver are involved.
Stage 1 The lymphoma is only in one group of lymph nodes in one particular area of the body.
Stage 2 More than one group of lymph nodes is affected, but all the affected nodes are contained within either the upper half or the lower half of the body. The upper half of the body is above the sheet of muscle underneath the lungs (the diaphragm) and the lower half is below the diaphragm.
Stage 3 Lymphoma is present in lymph nodes in both the upper and lower parts of the body (i.e. in lymph nodes both above and below the diaphragm). Your spleen is considered as a lymph node in this staging system.
Stage 4 The lymphoma has spread beyond lymph nodes to other organs – for example, to sites such as the nervous system, bone marrow, liver or lungs.
The stage usually includes the letter A or B, which describes whether any B symptoms are present or not (e.g. stage 2B). Sometimes the lymphoma can start in areas outside the lymph nodes, and this is represented by the letter E, which stands for extranodal (e.g. stage 3AE).
Grading
For practical purposes, non-Hodgkin’s lymphomas are divided into two groups: low- and high-grade. Low-grade lymphomas are usually slow-growing and high-grade lymphomas grow more quickly.
Burkitt’s lymphoma is a high-grade lymphoma and needs prompt treatment.
Treatment
The following drugs may be used in various combinations to treat Burkitt's lymphoma; cyclophosphamide, doxorubicin, vincristine, methotrexate, cytarabine, ifosfamide and etoposide. CancerBACUP also has information on the chemotherapy drugs
Chemotherapy
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It is the main treatment for this type of lymphoma. The chemotherapy treatment may differ slightly depending on how many areas of the body are affected. It is usually quite intensive and is likely to involve a stay in hospital. Usually the chemotherapy drugs are given into a vein (intravenously). As there is a risk that this type of lymphoma may spread into the nervous system, chemotherapy drugs are also usually injected into the fluid around the spinal cord in a procedure similar to a lumbar puncture. This is known as intrathecal chemotherapy.
The following drugs may be used in various combinations to treat Burkitt’s lymphoma: cyclophosphamide (pronounced sigh clo fos fa mide), doxorubicin (docks o rou bi sin), vincristine (vin chris teen), methotrexate (me tho trex ate), cytarabine (sigh tare a been), ifosfamide (i fos fa mide) and etoposide (e top o side).
High-dose treatment with stem cell support
High-dose chemotherapy with bone marrow or stem cell infusions has been used for some patients. This type of treatment involves very intensive chemotherapy and sometimes radiotherapy.
As the side effects can be severe, some types of high-dose treatment are not given to people over the age of 45–50 while others can be given to people of up to 65 years who are fit enough. The intensity of the treatment increases the risks of serious side effects for people over these ages.
Steroid therapy
Steroids are drugs which are often given with chemotherapy to help treat lymphomas. They also help you to feel better and can reduce feelings of sickness.
Clinical Trials
New treatments for Burkitt’s lymphoma are being researched all the time, and you might be invited by your doctor to take part in a clinical trial to compare a new treatment against the best available standard treatment. Your doctor must discuss the treatment with you and have your informed consent before entering you into any clinical trial.
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