Burkitt Lymphoma: What it is, Symptoms, Causes and Treatment

Introduction

Have you ever wondered how your body fights off infections? B-cells are a type of white blood cells (WBC) that help your body fight off infections. Burkitt lymphoma (BL) is a type of cancer that affects these B-cells and causes them to grow uncontrollably. It’s a very aggressive cancer that can spread quickly throughout the body. The exact causes of Burkitt lymphoma are still not fully understood, but we do know that certain factors like viral infections and genetic mutations can increase the risk of developing this disease.  

There are three types of Burkitt lymphoma: endemic, sporadic, and immunodeficiency-related.

• Endemic Burkitt Lymphoma: Linked to Malaria and Epstein-Barr virus (EBV).
• Sporadic Burkitt Lymphoma: Linked to Genetic mutations.
• Immunodeficiency-Related Burkitt Lymphoma: Linked to HIV or organ transplantation.

Let us dive deeper into what Burkitt lymphoma is, its causes and types, how it is diagnosed and treated, and the role of healthcare professionals towards it. ¹

Signs And Symptoms Of Burkitt Lymphoma

Burkitt lymphoma can have different signs and symptoms depending on the type of the disease. However, some symptoms may be similar to each other. They are as follows: 

1. Sporadic BL

Signs:

• One or more painless swellings that are enlarged lymph nodes
• If Burkitt lymphoma is present in the abdomen area, it might cause discomfort in the back and abdomen, vomiting, swelling of the abdomen, bleeding, and painful bowel obstruction.

Symptoms:

• Heavy sweating at night, high temperatures that come and go, and losing a lot of weight

2. Immunodeficiency-related BL

Signs:

• Painless swelling on lymph nodes.
• If Burkitt lymphoma is present in the abdomen, it might cause discomfort in the back or abdomen, vomiting, swelling of the abdomen, bleeding, and painful bowel obstruction.

Symptoms:

• Heavy sweating at night
• Fever
• Excessive unexplained weight loss

3. Endemic BL

Signs:

• Lymph nodes that are swollen but not painful
• Pain in your abdomen

Symptoms:

• Sweating at night that soaks your clothes and bedding
• Fever
• Unexplained weight loss
• Extreme fatigue
• Nausea
• Vomiting
• Weakness, extreme tiredness, higher risk of infection, and higher risk of bleeding if the lymphoma involves your bone marrow.^2-4

When To See A Doctor

If you experience any of the following symptoms as mentioned above, it is important to see a doctor for an accurate diagnosis and prompt treatment.  

Causes Of Burkitt Lymphoma

Here are the major causes of Burkitt Lymphoma:

1. Epstein-Barr Virus (EBV)

• EBV is associated with nearly 100% of cases of endemic Burkitt lymphoma in Africa.
• In Western countries, about 30% of sporadic Burkitt lymphoma cases and 40% of immunodeficiency-associated cases are linked to EBV.

2. HIV/AIDS

• Immunodeficiency-associated Burkitt lymphoma often occurs in people who have HIV, AIDS, or take immunosuppressive drugs after an organ transplant.

3. Chromosomal

• In Burkitt lymphoma, there is a change in a specific chromosome called chromosome 8 that affects ‘c-MYC’. This change happens because a part of chromosome 8 gets swapped with a part of either chromosome 14, 2, or 22. This change can cause cells to grow too much and too fast, leading to Burkitt lymphoma.^1,5

Risk Factors For Burkitt Lymphoma

Here are some risk factors for Burkitt lymphoma:

• Infection with the Epstein-Barr virus (EBV): Burkitt’s lymphoma is more common in Africa and is linked to the Epstein-Barr virus. The Epstein-Barr virus is a common virus that infects most people at some point in their lives. However, in some cases, the virus can cause abnormal B cells to develop, which can lead to Burkitt lymphoma. 
• Weakened immune system
• Lesser Age 
• Geography: Burkitt lymphoma is more common in equatorial Africa, where it is associated with the Epstein-Barr virus and malaria.  
• Family history and genetic predisposition
• Exposure to pesticides or insecticides^1,6,7

It’s important to note that having one or more of these risk factors does not necessarily mean a person will develop Burkitt lymphoma. It merely increases the chances of its occurrence.

Diagnosis Of Burkitt Lymphoma

Burkitt’s lymphoma is a rare and aggressive type of non-Hodgkin’s lymphoma that affects B-cells. The following are some diagnostic methods or tests done for Burkitt’s lymphoma:

• Biopsy: A sample of the affected lymph node is removed and examined under a microscope to confirm the diagnosis of Burkitt’s lymphoma.
• Blood tests: Blood tests may be done to check the number of white blood cells, red blood cells, and platelets in the bloodstream.
• Imaging tests: Imaging tests such as X-rays, CT scans, MRI scans, or PET scans may be done to determine the location and extent of the cancer.
• Bone marrow biopsy: A small sample of bone marrow is taken and examined under a microscope to see if cancer cells are present.
• Lumbar puncture: A small sample of cerebrospinal fluid is taken from the spinal cord to check if the cancer has spread to the central nervous system.
• Flow cytometry: This is a laboratory technique that analyzes cells in a sample to identify specific markers on the surface of the cells. This can help in the diagnosis of Burkitt’s lymphoma.
• Molecular testing: Molecular testing can identify genetic changes or mutations that are characteristic of Burkitt’s lymphoma.
• Immunohistochemistry: This is a technique used to identify specific proteins in the cancer cells that are associated with Burkitt’s lymphoma.
• Staging: The stage of the cancer is determined based on the size and location of the tumour, as well as the extent of its spread to other parts of the body. This helps determine the appropriate treatment plan.^1,8

Treatment Of Burkitt Lymphoma

Here are some treatment options for Burkitt lymphoma:

• Chemotherapy and immunotherapy: Combination of chemotherapy drugs and rituximab, an immunotherapy drug, is the standard treatment for Burkitt lymphoma.
• Chemotherapy to stop spread to the brain: Certain situations might require injections of the chemotherapy drug methotrexate into the fluid around the spinal cord or high-dose methotrexate injected into the vein to prevent the spread of lymphoma to the brain and spinal cord.
• Surgery: Surgery is uncommon in the treatment of Burkitt lymphoma. It is only used to relieve symptoms caused by a blockage.
• Radiotherapy: Radiotherapy may be used to relieve symptoms caused by a blockage or before a stem cell or bone marrow transplant.
• Follow-up: Regular follow-up appointments are necessary to monitor the patient’s health and detect any relapses or side effects after treatment.^1,4

Prevention Of Burkitt Lymphoma

Prevention may be a key in managing Burkitt lymphoma. Let us see some preventive measures to follow:

• Early diagnosis: Early diagnosis of Burkitt lymphoma can lead to timely treatment, which can improve the chances of a cure and prevent the disease from spreading to other parts of the body. This is why it is important to be aware of the signs and symptoms of lymphoma and seek medical attention promptly if any are present.
• Detection: Regular check-ups and screening tests can also help with early detection in people who are at higher risk for the disease, such as those with weakened immune systems.
• Healthy lifestyle: Maintaining a healthy diet and lifestyle, including regular exercise, a balanced diet, and avoiding smoking and excessive alcohol consumption.
• Good hygiene: Practicing good hygiene, such as washing hands regularly to reduce the risk of infection.
• Knowing the symptoms: Knowing the symptoms of Burkitt lymphoma can help with early detection. Symptoms include swelling of the lymph nodes, fever, night sweats, weight loss, and fatigue. Seeking prompt medical attention if you develop symptoms of an infection or other illness, as early diagnosis and treatment can help prevent complications and support a healthy immune system.^9,10

Complications Of Burkitt Lymphoma

Burkitt’s lymphoma, a type of cancer that affects the lymphatic system (the part of our body that fights off infections and keeps our fluid balance normal), can have several complications. They can be divided into three types and are discussed below:

1. Tumour-related:

• Tumour growth: Burkitt lymphoma can cause tumours to grow in various parts of the body, which can cause pain and discomfort.
• Swelling: Lymphoma can cause swelling in the lymph nodes, which are located throughout the body. This might make it difficult to move or perform certain activities.
• Tumour lysis syndrome: When cancer cells die, they release a large amount of waste products into the bloodstream. This can cause a variety of problems, including kidney damage, electrolyte imbalances, and heart problems.

2. Patient-related:

• Immune system problems: Cancer can weaken the immune system, which can make it difficult for the body to fight off infections.
• Compression of organs: Tumours can grow to a size that compresses organs such as the lungs, leading to breathing difficulties.

3. Treatment-related:

• Chemotherapy side effects: The medications used to treat Burkitt lymphoma can cause a variety of side effects, including nausea, hair loss, and fatigue.
• Treatment completion: Due to the high cost of treatment, lack of access to medical care, and health illiteracy, many patients with Burkitt’s lymphoma do not complete their treatment, which can reduce their chances of long-term survival.
• Prognosis: In patients with endemic Burkitt’s lymphoma, a 1-year event-free survival rate of less than or equal to 5% is associated with a low risk of relapse and good long-term survival.
• HIV-related Burkitt’s lymphoma: It is more difficult to manage than non-HIV-related Burkitt’s lymphoma because immunocompromised patients may not be able to tolerate full doses and courses of chemotherapy and often die of infections.

It’s important to work closely with your healthcare team to manage these complications and maintain your overall health.^1,11

Research Facts About Burkitt Lymphoma

Let us see some interesting facts about Burkitt lymphoma:

• Burkitt Lymphoma was first described by Dr. Denis Burkitt in 1958, while working as a missionary in Uganda, where he observed a high incidence of jaw tumours in children.
• In well-developed nations, the cure rate for sporadic Burkitt lymphoma is almost about 90% in children and young adults.^1,12

Frequently Asked Questions (FAQs)

References:

1. Graham BS, Lynch DT. Burkitt Lymphoma. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538148/ 
2. Burkitt lymphoma symptoms and diagnosis [Internet]. [cited 2023 May 11]. Available from: https://bloodcancer.org.uk/understanding-blood-cancer/lymphoma/burkitt-lymphoma/about-burkitt-lymphoma/burkitt-lymphoma-symptoms-diagnosis/ 
3. Burkitt lymphoma [Internet]. [cited 2023 May 11]. Available from: https://lymphoma-action.org.uk/types-lymphoma-non-hodgkin-lymphoma/burkitt-lymphoma#symptoms 
4. Burkitt lymphoma [Internet]. 2020 [cited 2023 May 11]. Available from: https://www.cancerresearchuk.org/about-cancer/non-hodgkin-lymphoma/types/burkitt-lymphoma 
5. Burkitt’s lymphoma [Internet]. 2023 [cited 2023 May 11]. Available from: https://www.leukaemia.org.au/blood-cancer/lymphoma/non-hodgkin-lymphoma/burkitts-lymphoma/ 
6. Karimi P, Birmann BM, Anderson LA, McShane CM, Gadalla SM, Sampson JN, Mbulaiteye SM. Risk factors for Burkitt lymphoma: a nested case‐control study in the UK Clinical Practice Research Datalink. British journal of haematology. 2018 May;181(4):505-14. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5980720/
7. Rowe M, Fitzsimmons L, Bell AI. Epstein-Barr virus and Burkitt lymphoma. Chinese journal of cancer. 2014 Dec;33(12):609. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4308657/ 
8. Tests for Non-Hodgkin Lymphoma [Internet]. [cited 2023 May 11]. Available from: https://www.cancer.org/cancer/types/non-hodgkin-lymphoma/detection-diagnosis-staging/how-diagnosed.html 
9. Park K. Park’s textbook of Preventive and Social Medicine. 26th ed. M/s BANARSIDAS BHANOT PUBLISHERS; 2019. Available from: https://drive.google.com/file/d/1d_bV9iUe3M3woxX5uhrZPg90SGyMtRrg/view 
10. Can non-hodgkin lymphoma be prevented? [Internet]. [cited 2023 May 11]. Available from: https://www.cancer.org/cancer/types/non-hodgkin-lymphoma/causes-risks-prevention/prevention.html  
11. Levine AM. Challenges in the management of Burkitt’s lymphoma. Clinical lymphoma. 2002 Dec 1;3:S19-25. Available from: https://pubmed.ncbi.nlm.nih.gov/12521385/
12. Magrath L. Denis Burkitt and the African lymphoma. ecancermedicalscience. 2009 Sept; doi:10.3332/ecancer.2009.159. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3224008/ 

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