Burkitt Lymphoma in Children
Overview
Burkitt lymphoma is a rare, fast-growing form of non-Hodgkin lymphoma (NHL). It’s
a
type of cancer that starts in white blood cells in the lymphatic system. The lymphatic
system is part of the immune system. It helps to fight diseases and infections. The
lymphatic system also helps balance fluids in different parts of the body. The lymphatic
system includes:
-
Lymph. This is a clear fluid that contains white blood cells called
lymphocytes.
-
Lymph
vessels
. These are tiny tubes that carry lymph fluid all over the body.
-
Lymphocytes. These are a type of white blood cell that fights infections and
disease. Burkitt lymphoma starts in one type of lymphocyte called B-cells.
-
Lymph
nodes.
These are small bean-shaped organs. They're scattered all over the
body. They're connected by lymph vessels. And they filter the lymph fluid as
it moves around the body.
-
Other organs
and body tissues.
The lymphatic system includes the bone marrow where blood
is made. It also includes the spleen, thymus, tonsils, and digestive tract.
There are 3 main types of Burkitt lymphoma:
-
Endemic
(African).
Endemic means it is common in one area. This type is a common
childhood cancer in central Africa and New Guinea. It causes large tumors of the face
and jaw. It's rare in the U.S.
-
Sporadic
(nonendemic).
This is the type most often seen in the U.S. and Western
Europe. It often causes large tumors in the belly (abdomen).
-
Immunodeficiency-associated. This type mostly affects people with HIV
infection. The lymph nodes, bone marrow, and brain and spinal cord (central nervous
system) are often affected.
Risk Factors
In children, Burkitt lymphoma is most
common in boys between ages 5 and 10.
Causes
Like
other types of NHL, the exact cause of Burkitt lymphoma isn't known. Some viral
infections may increase a child’s risk of having Burkitt lymphoma. The viruses that
are
linked to Burkitt lymphoma include:
- Epstein-Barr virus (EBV), the virus that causes mono (mononucleosis)
- HIV, the virus that causes AIDS
Symptoms
The symptoms of Burkitt lymphoma start suddenly, and the tumors tend to grow very
quickly. A child can become very sick in a few days to a few weeks. Symptoms of a
belly (abdominal) tumor can include:
- Abdominal pain and swelling
- Nausea
and vomiting
- Trouble
with bowel movements (constipation)
- Poor appetite
- Feeling
full quickly, such as after eating a small amount of food
Other symptoms may include:
- Painless
swelling of the lymph nodes in the neck, chest, abdomen, underarm, or groin
- Fever
- Chills
- Night
sweats
- Tiring
easily (fatigue)
- Weight
loss
- Itchy
skin
- Coughing or trouble breathing
The symptoms of Burkitt lymphoma can look like other health conditions. Make sure
your child sees a healthcare provider for a diagnosis.
Diagnosis
Your
child's healthcare provider will ask about your child's health history and symptoms.
He
or she will examine your child. Your child may need tests such as:
-
Blood and
urine tests.
Blood and urine samples are tested in a lab.
-
Tissue
biopsy.
A small tissue sample is taken from the tumor, lymph nodes, or other
tissue. It’s checked with a microscope for cancer cells.
-
Chest
X-ray
. This shows the heart, lungs, and other parts of the chest.
-
CT scan.
This may be done to look at the abdomen, chest, and pelvis. A CT scan uses a
series of X-rays and a computer to make detailed pictures of the inside of the body.
Your child may drink a contrast dye. Or a dye may be injected into a vein. The dye
helps show more details.
-
MRI
scan.
An MRI uses large magnets, radio waves, and a computer
to make detailed pictures of the inside of the body. This test is used to check the
brain and spinal cord. Or it may be used if the results of an X-ray or CT scan are
unclear.
-
Ultrasound.
This is also called sonography. Sound waves and a computer are used to make
pictures of blood vessels, tissues, and organs.
-
Bone marrow
aspiration or biopsy.
Bone marrow is found in the center of some bones. It’s
where blood cells are made. A small amount of bone marrow fluid may be taken out.
This is called aspiration. Or solid bone marrow tissue may be taken. This is called
a
core biopsy. Bone marrow is often taken from the back of the hip bone. This test may
be done to see if cancer cells have reached the bone marrow.
-
Lumbar
puncture (spinal tap).
A thin needle is placed between the bones in the lower
back and into the spinal canal. This is the area around the spinal cord. This is
done to see if there are cancer cells in the brain and spinal cord. A small amount
of
cerebral spinal fluid (CSF) is taken out and sent for testing. CSF is the
fluid around the brain and spinal cord.
Part
of diagnosing cancer is called staging. Staging is the process of seeing if the cancer
has spread, and where it has spread. Staging also helps to decide on the best treatment.
There are different ways of staging NHL. But most range from stage 1 to stage 4. Stage
4
is cancer that has spread to parts of the body that are not part of the lymphatic
system. Talk with your child's healthcare provider about the stage of your child's
cancer and what it means.
Treatment
Treatment will depend on the type and stage. Burkitt lymphoma is often treated
with:
-
Chemotherapy medicines (chemo). These are medicines that kill cancer cells
or stop them from growing. This is the main treatment for Burkitt lymphoma. Often
more than one type of chemo is used. If cancer cells are found in the CSF, chemo will
need to be given in that area too.
-
Surgery. If there's only one large tumor, surgery may be done to remove
it. This is done before chemotherapy.
-
Clinical
trials.
Ask your child's healthcare provider if there are any treatments
being tested that may work well for your child. Many new treatments are only
available in clinical trials.
Burkitt
lymphoma grows quickly and the tumors are often very big. When chemo starts, it kills
a
lot of cancer cells in a short time. These dead cells can build up in your child's
body
and cause a problem called tumor lysis syndrome (TLS). TLS can cause kidney damage
and
problems with the heart and nervous system. Your child will be given medicines and
a lot
of IV fluids to help keep this from happening.
Your child will need follow-up care during and after treatment to:
- Check on your child's response to the treatment
- Manage the side effects of treatment
- See if
cancer has returned or spread
With treatment, most children with Burkitt lymphoma go on to live long lives. With
any cancer, how well a child is expected to recover (prognosis) varies. Keep in mind:
- Getting medical treatment right away is important for the best prognosis.
- Ongoing follow-up care during and after treatment is needed.
- New treatments are being tested to improve outcome and to lessen side effects.
- Talk
with the doctor about any concerns you may have or problems you may notice. Your
child's treatment team wants to know as much as they can about how your child is
doing.
Complications
Possible complications depend on the type and stage of the lymphoma, as well as the
treatment used. Your child may have short- and long-term problems from the tumor or
from
treatment. They may include things like:
- Increased risk for infection
- Increased risk for bleeding
- Heart
disease
- Lung
problems
- Increased risk for having other cancers later in life
- Trouble
having children (infertility)
- Death
- Nausea
and vomiting
- Diarrhea
- Poor
appetite
- Sores in
the mouth
- Hair
loss
Talk with
the doctor about what you should watch for and what can be done to help prevent
complications.
Living with
You can help your child manage his or her treatment in many ways. For example:
- Your
child may have trouble eating. A dietitian may be able to help.
- Your
child may be very tired. He or she will need to balance rest and activity. Encourage
your child to get some exercise. This is good for overall health. And it may help
to
lessen tiredness.
- Get
emotional support for your child. Find a counselor or child support group that can
help.
- Make
sure your child goes to all follow-up appointments.
When to Call a Healthcare Provider
Call the healthcare provider if your child has:
- Symptoms that get worse
- New symptoms
- Side effects from treatment
Key Points
- Burkitt lymphoma is a very fast-growing type of non-Hodgkin lymphoma.
- It often causes large belly (abdominal) tumors.
- A child
may have swollen lymph nodes, tiredness, fever, and other symptoms.
- It's
treated with chemotherapy and surgery.
- With treatment, most children with Burkitt lymphoma go on to live long lives.
- Ongoing
care is important.
Next Steps
Tips to help you get the most from a visit to your child’s healthcare provider:
- Know the reason for the visit and what you want to happen.
- Before your visit, write down questions you want answered.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
or tests. Also write down any new instructions your provider gives you for your child.
- Know why
a new medicine or treatment is prescribed and how it will help your child. Also know
what the side effects are.
- Ask if your child’s condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if your child does not take the medicine or have the test or procedure.
- If your child has a follow-up appointment, write down the date, time, and purpose
for that visit.
- Know
how you can contact your child’s provider after office hours. This is important if
your child becomes ill and you have questions or need advice.