Burkitt Lymphoma: Symptoms, Causes, Pictures, Treatment

Burkitt lymphoma (BL) is a severe non-Hodgkin lymphoma. Burkitt lymphoma histology often shows a widespread expansion of medium-sized, non-cleaved B cells with a high maturation rate. 

The condition is linked to Epstein-Barr virus (EBV), HIV, and chromosomal translocations that result in the amplification of the oncogene c-myc. Patients with Burkitt lymphoma frequently have an MYC-simple Burkitt’s lymphoma karyotype (a person's entire set of chromosomes).

Burkitt's non-hodgkin's lymphoma is endemic in places like Brazil, Papua New Guinea, and equatorial Africa, where malaria is holoendemic (a condition in which a high prevalence level of infection starts early in life and impacts the majority of the youth population). 

Burkitt lymphoma makes up about 1% to 5% of all non-Hodgkin lymphomas. BL, like most kinds of lymphoma, is more common in men, with a 3 to 4:1 male-to-female ratio.

Burkitt Lymphoma Translocation

Burkitt lymphoma is distinguished by genetic abnormalities, most notably chromosomal translocations affecting the MYC gene (a family of genes that makes proteins for several cell functions). These Burkitt lymphoma translocations cause overexpression of the MYC oncogene, essential for cell proliferation and division.  

The most prevalent translocation in Burkitt’s lymphoma is t(8;14)(q24;q32), which occurs when the MYC gene on chromosome 8 meets the immunoglobulin heavy chain gene (IGH) on chromosome 14. This translocation causes the MYC gene to be imbalanced and overexpressed, causing unusual cell growth and the development of tumors.

In Indian children, Burkitt Lymphoma accounts for just 0.76% of solid malignant tumours, making it a very uncommon form of cancer. Geographical location and the body sections it impacts are two factors that distinguish the types of Burkitt’s lymphoma, which are:

1. Endemic: Africa is the region of origin for endemic Burkitt lymphoma. It is also the most common Burkitt lymphoma of all childhood cancers. The jaw is where endemic illness most frequently manifests. It has been established that the endemic variant of Burkitt lymphoma is associated with the Epstein-Barr virus (EBV).

2. Sporadic: The sporadic form of Burkitt lymphoma exists worldwide. However, it contributes to 30% of all children's lymphoma. The most typical location for this type of Burkitt's lymphoma to manifest itself is an abdominal tumour.

3. Immunodeficiency-Related: People with acquired immunodeficiency syndrome (HIV/AIDS) are more susceptible to this cancer. Additionally, it can happen to people who take immunosuppressive drugs to avoid organ rejection after transplantation or those who have inherent immune weaknesses.

Burkitt Lymphoma Stages

World Health Organization (WHO) classification system is generally used to stage Burkitt lymphoma. This approach considers how far a disease has spread and aids in selecting the most effective Burkitt lymphoma treatment guidelines. The following describes the Burkitt lymphoma staging:

1. Stage 1: When the cancer is contained in one lymph node area or one organ outside the lymphatic system, it is said to be in stage one.

2. Stage 2: Cancer may affect two or more lymph node areas on the same side of the diaphragm, or it may only affect one lymph node region and a nearby organ.

3. Stage 3: The spleen, liver, bone marrow, or other extra lymphatic organs have all been affected by the spread of cancer cells as well as lymph node regions on both sides of the diaphragm.

4. Stage 4: The central nervous system (brain and spinal cord), bone marrow, or other organs outside the lymphatic system have all been affected by the cancer's spread.

Depending on the type, Burkitt lymphoma has different symptoms. In the endemic (African) variation, tumours of the jaw or other bones in the face are frequently the first signs. 

Sporadic and immune-deficiency-related typically begin in the intestine and develop into a large tumour mass in the abdomen, frequently including the liver, spleen, and bone marrow heavily.

Other Endemic Burkitt’s Lymphoma Symptoms

1. Fast lymph node expansion

2. Tumours size doubling quickly

3. Fever

4. Unusual weight loss

5. Extreme fatigue

6. Nausea

Other Immune-deficiency-related and Sporadic Burkitt’s Lymphoma Symptoms

1. Sweating during the night

2. Intestinal obstruction

3. An enlarged thyroid

4. Oversized tonsils

Burkitt’s lymphoma's specific cause is unknown. However, some individuals have a higher risk of developing the disease than others. Here are some common causes:

1. Epstein-Barr Virus (EBV): Strong links exist between Epstein-Barr virus infection and the endemic type of Burkitt lymphoma. Equatorial Africa and Papua New Guinea are the main locations where this type is found.

2. Human Immunodeficiency Virus (HIV): Burkitt lymphoma and human immunodeficiency virus (HIV) are related. Please note that having EBV or HIV does not guarantee that one will get this kind of cancer. 

   As Burkitt lymphoma advances, weakness and weariness may occur. HIV may also present with these symptoms, making it a condition that medical professionals need to rule out before a diagnosis can be made.

3. Genetics: Genetic mutations affecting genes like the MYC gene cause nearly all cases of Burkitt lymphoma. Researchers don't know what causes the alterations in the genes that produce this particular type of Burkitt's non-Hodgkin lymphoma, but they are not hereditary.

Burkitt Lymphoma Risk Factors 

Risk factors change depending on where one resides. According to research, Burkitt's lymphoma is the most prevalent childhood cancer in areas with a high prevalence of malaria, such as Africa. Listed below are the major risk factors involved in Burkitt's lymphoma.

1. Immune System Weakness: Burkitt non-Hodgkin's lymphoma is more likely to develop in those with immune system deficiencies. 

2. Geographical Distribution: Burkitt lymphoma manifests distinct geographic patterns. In equatorial Africa, especially in areas where the spread of malaria is substantial, Burkitt lymphoma is endemic. Although sporadic Burkitt lymphoma occurs everywhere, it is more prevalent in some areas, such as the United States, Europe, and some parts of Asia.

3. Age: Children and young adults are most commonly affected by Burkitt’s lymphoma, with the largest prevalence between the ages of 5 and 20. 

Due to the complexity of the illness and the incomplete knowledge of its precise origins, prevention measures for Burkitt lymphoma are not yet well-defined. However, there are several steps that can be taken to lower the risk of Burkitt lymphoma: 

1. Detection: Regular check-ups and screenings can aid in the early identification of the disease in those more vulnerable to it, such as individuals with compromised immune systems.

2. Early Diagnosis: Early detection of Burkitt lymphoma can result in prompt treatment, increasing the likelihood of a successful cure and halting the spread of the illness to other body regions. This is why it's crucial to be aware of all the signs of lymphoma and to get help right away if any of them appear.

3. Healthy Lifestyle and Good Hygiene: The immune system needs to be kept strong by maintaining a healthy lifestyle and good hygiene, such as getting regular exercise, eating a balanced diet, and abstaining from smoking and excessive alcohol use. Regular hand washing can also help lower the risk of infection.

Since Burkitt lymphoma spreads so rapidly, early diagnosis and Burkitt lymphoma treatment is crucial. If Burkitt lymphoma is identified, a swollen lymph node or other suspect disease locations will undergo full or partial biopsy. A biopsy involves examining a sample of tissue through a microscope. Burkitt lymphoma will either be found to exist or not. Other tests involved in the diagnosis of Burkitt lymphoma are:

1. Computed Tomography (CT) Scans: The individual's pelvis, abdomen, and chest may be scanned by medical professionals to check for cancerous signs.

2. Positron Emission Tomography (PET) Scans: This is yet another imaging examination that aids in the search for tumors.

3. Cerebrospinal Fluid Cytology: Cerebrospinal fluid can be obtained by providers to screen for cancerous cells.

4. Lactic Dehydrogenase (LDH) Test: LDH levels in the blood are measured by medical professionals. An elevated LDH level could indicate lymphoma.

Additional tests include:

1. Chest X-ray

2. Bone marrow biopsy

3. Blood tests to analyse kidney and liver functions

4. Testing for HIV 

How to Prepare for Doctor’s Consultation?

Arranging the medical history, compiling important information, and creating a list of inquiries to ask the doctor are all necessary steps in getting ready for a Burkitt lymphoma session. To effectively prepare, one should take the following measures:

1. Collecting Medical Records: Gather all relevant medical information, such as Burkitt lymphoma pathology outlines, imaging scans, and the findings of earlier tests.

2. List All The Burkitt Lymphoma Symptoms: Even if the symptoms seem unconnected to Burkitt lymphoma, note them down. Include information about the severity of the symptoms, when they first appeared, and any circumstances that may have contributed to their onset.

3. Create a List of Inquiries: Make a list of questions to bring up with the doctor, such as expected risk factors, essential tests, potential side effects, and more.

4. Pay Attention to Pre-consultation Instructions: If the doctor has provided any specific guidelines to follow before the visit, such as fasting or stopping a certain medication, be sure to follow them.

What to Expect from the Doctor?

The healthcare professional will ask a number of questions to learn more about the patient's medical history, symptoms, and general health during a consultation for Burkitt lymphoma.  One can anticipate the following from a Burkitt lymphoma doctor's consultation:

1. Medical History Review and Physical Exam: The doctor will start by going over the patient's medical history or Burkitts lymphoma histology, which includes any existing medical conditions, any symptoms they may have been having, and any pertinent family history. 

2. Diagnostic Testing: The doctor will conduct particular diagnostic tests like blood tests, imaging scans, and biopsy to confirm the diagnosis. If Burkitt lymphoma has been identified based on the patient's symptoms and physical examination. 

3. Choices for Therapy: Following a Burkitt lymphoma diagnosis and stage determination, the doctor will go over the various treatment choices.

4. Questions and Discussion: The doctor will urge patients to ask questions and talk about any issues they may have throughout the appointment. 

Questions to Ask the Doctor

Asking appropriate inquiries will help the patient to better grasp the diagnosis, available treatments, and outlook while speaking with the doctor about Burkitt lymphoma. Consider asking the following queries:

1. What exactly is Burkitt lymphoma, and how does it impact my body?

2. What tests or methods were performed to confirm a Burkitt lymphoma diagnosis?

3. What is the stage of my Burkitt lymphoma? Can you describe what the stage entails in terms of disease severity?

4. What Burkitt lymphoma therapy options are available, and which one do you advise for me? 

5. What are the treatment's objectives, and what can I expect?

6. How long is the treatment plan expected to last, and what does it represent?

7. What are the possible side effects of the prescribed treatment, and how may they be dealt with?

8. Are there any alternative or additional therapies that could be used besides regular treatment?

9. How will Burkitt lymphoma therapy affect my daily life, including job, family, and other responsibilities?

10. Are there any Burkitt lymphoma support groups or resources accessible for patients and their families?

11. Are there any dietary or lifestyle adjustments I should make during or after treatment?

Burkitt’s lymphoma requires a thorough and extensive approach to treatment. Prompt Burkitt lymphoma treatment is essential due to the cancer cells' rapid development and tendency for broad transmission. Burkitt lymphoma frequently responds very well to the intense chemotherapy regimens currently advised, and cure rates for this illness continue to be high.

Depending on whether a patient is at low or high risk, different  Burkitt lymphoma treatment guidelines are available. Similar combinations of medications are used to treat diseases with low and high risk, while high-risk patients receive additional care. All of the therapies are rigorous and often involve administering high dosages of medication.

The patient will likely undergo one of the following treatment plans:

1. Chemotherapy: Burkitt lymphoma responds well to this treatment. The "R-CODOX-M/IVAC" regimen, which combines cyclophosphamide, vincristine, doxorubicin, methotrexate, and cytarabine, is the most widely used chemotherapy regimen. 

2. Immunotherapy: Immunotherapy is an option for Burkitt lymphoma patients, especially those who have certain genetic abnormalities, like the MYC gene rearrangement. 

3. Intrathecal Therapy: Burkitt lymphoma is capable of spreading to the central nervous system (CNS). Intrathecal chemotherapy is provided directly into the cerebrospinal fluid (CSF) in order to prevent or treat CNS involvement. 

4. Radiation Therapy: Radiation therapy may be employed in some circumstances, especially when the disease only affects a small area or if chemotherapy has left some residual disease.

5. Stem Cell Transplantation: In some situations, doctors may recommend a stem cell transplantation when a patient doesn't react to other Burkitt Lymphoma treatments. Medical professionals may also suggest this course of therapy to patients whose Burkitt lymphoma reoccurs. In a bone marrow transplant, stem cells are taken from the newborn's umbilical blood, peripheral blood, or bone marrow to replace the damaged stem cells.

Cost of the Burkitt Lymphoma Treatment

The cost of Burkitt lymphoma treatment in India varies based on several factors including the type and stage of cancer, the treatment modality used, the patient’s age, patient comorbidities, doctor’s expertise, type and location of the hospital, insurance coverage, and much more.

To know the cost of Burkitt lymphoma treatment in India, one must consult their healthcare provider. However, the below-mentioned table also provides the cost for the various treatment modalities used for Burkitt lymphoma treatment.

Burkitt Lymphoma Survival Rate

With improvements in Burkitt lymphoma treatment methods throughout time, Burkitt lymphoma's survival rate has considerably improved. Individual results, however, can vary depending on a number of variables, including age, illness stage, general health, and how they react to treatment. 

Burkitt lymphoma is renowned for its quick development and strong chemotherapeutic response. Success rates of up to 90% have been stated, especially among children and young people, with early diagnosis and vigorous treatment. 

Burkitt Lymphoma Prognosis

Burkitt lymphoma typically has a favorable prognosis, especially in children and young adults. The disease responds quite well to aggressive chemotherapy treatments. Patients with limited disease (Stages I and II) typically have a better prognosis than those with advanced cancer (Stages III and IV) or central nervous system invasion.

Additional therapy options, including stem cell transplantation or innovative targeted medicines, can be examined for patients who might suffer disease relapse or who have refractory illnesses in an effort to improve the prognosis.

The prognosis for Burkitt’s lymphoma has generally improved dramatically in recent years as a result of improvements in therapeutic strategies. However, because they can change depending on the unique patient characteristics and other clinical circumstances, it is crucial to discuss the exact prognosis and treatment choices with the medical team.

Burkitt lymphoma has a deadly outlook if left untreated. This cancer is extremely fast developing. Thus, it needs to be treated right away. The most common kind of treatment is vigorous chemotherapy, which has a unique set of possible risks and side effects, including:

1. Fatigue

2. Anaemia (inadequate red blood cell production)

3. Immune system deficiency

4. Bruising and bleeding are common.

5. Changes in appetite and weight

6. Vomiting and nausea

7. Constipation or diarrhoea

8. Hair thinning

9. Nerve issues such as numbness

10. Changes in the skin and nails

11. Urinary alterations

12. Focusing on problems

13. Mood swings 

14. Libido fluctuations

15. Fertility difficulties

A patient who develops tumour lysis syndrome may additionally go through the following complications:

1. Kidney injury

2. Muscle control loss

3. Seizures

4. Abnormal heartbeat

Risks of Delaying Treatment 

Burkitt lymphoma can have disastrous consequences if it is not treated right away. Here are some dangers and issues that could arise from Burkitt lymphoma that is left untreated:

1. Disease progression

2. Organ damage

3. Weakened immune system

4. Tumor lysis syndrome

5. Worsening of symptoms

When to See a Doctor?

It's critical to visit a doctor as soon as possible if one experiences any symptoms because Burkitt lymphoma is a severe tumour. Burkitt lymphoma develops rapidly into a lethal disease, in contrast to other malignancies that progress and spread slowly. Some signs of illness include:

1. Swollen lymph nodes

2. Weakness or unusual fatigue

3. Stomach ache

4. Sudden weight loss

5. Night Sweating

Each meal and dietary supplement is made up of a variety of active chemical components in varying ratios and concentrations. While various active elements in the same meal may be helpful in the context of Burkitt lymphoma, other active substances in foods can combine in ways that are harmful. Here are some dietary recommendations for patients with Burkitt lymphoma:

1. Balanced Diet: A well-rounded diet that contains a variety of nutrient-dense foods is ideal. Fruits, vegetables, entire grains, lean proteins, and healthy fats are common examples.

2. Fruits and Vegetables: These can be beneficial to one's immune system and overall health. Consuming at least five servings of fruits and vegetables daily is widely recommended.

3. Whole Grains: Patients should choose whole grains over refined grains such as whole wheat, brown rice, quinoa, and oats. When opposed to refined grains, whole grains include more fiber, vitamins, and minerals.

4. Hydration: It is critical for patients to stay hydrated by having plenty of water and other fluids. This is especially crucial during cancer treatment because some medications might cause dehydration or disrupt the body's fluid balance.

Burkitt lymphoma is a kind of non-Hodgkin lymphoma that is extremely aggressive and mostly attacks B cells. It is distinguished by quickly developing tumors, which frequently manifest as enlarged lymph nodes. Treatment usually entails intense chemotherapy, and with timely and competent management, the outcome is generally good.

At HexaHealth, our devoted team of medical specialists is committed to helping people with Burkitt lymphoma. From the initial diagnosis to continuing maintenance, we offer complete care. We provide individualized, empathetic support to those impacted by Burkitt lymphoma, whether it be by assisting patients through diagnostic procedures, going over available treatments, or offering supportive care. To find out more about our offerings and how we may help you on your path to better health, get in touch with us. 

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