All about Burkitt lymphoma
Burkitt lymphoma starts in B cells, which are a type of white blood cell. Usually B cells protect your body from infection. In Burkitt lymphoma, B cells grow in an out of control way and donโt function normally. It can begin in different parts of the body.
If it starts in your lymph nodes (small glands that help fight infection), it’s called nodal.
If it starts outside the lymph nodes (like in your organs or bone marrow), it’s called extra nodal.
Symptoms of Burkitt lymphoma
Burkitt lymphoma is a fast growing blood cancer. This means symptoms can appear suddenly and get worse quickly.
Some common symptoms include:
- painless swelling in the neck, armpit or groin
- abdominal pain or feeling full for no reason
- nausea, vomiting or diarrhoea
- fevers without infection
- tired for no reason
- drenching night sweats
- weight loss without trying
- confusion or memory changes.
Causes of Burkitt lymphoma
There is no specific cause of Burkitt lymphoma. There are links between genetic changes in a gene called MYC, which helps control cell growth, and exposure to certain viruses.
Some factors that can increase your risk of developing Burkitt lymphoma include:
- previous exposure to Epstein Barr virus (EBV)
- your age, it is more common in children and young adults
- gender, it is 4 times more likely in males than females
- where you live, it is more common in areas where there is malaria
- low immunity from medicines or a virus like as HIV
- family history of lymphoma.
Staging Burkitt lymphoma
Your Burkitt lymphoma will be staged using the results of your diagnostic tests. You will have either stage 1, 2, 3 or 4 disease.
Stage 1 and 2 are early stage disease, and stage 3 and 4 are advanced disease. Often people have stage 3 or 4 disease at diagnosis because it is very fast growing.
Stage 1
One lymph node area is affected, either above or below the diaphragm.
Stage 3
At least one lymph node area above and at least one lymph node area below the diaphragm.
Stage 2
Two or more lymph node areas are affected on the same side of the diaphragm.
Stage 4
Lymphoma is in multiple nodes and has spread to other parts of the body (eg. bones, lungs, liver).
The diaphragm is a thin, dome-shaped muscle that sits under your lungs and above your stomach.
Types of Burkitt lymphoma
The World Health Organization (WHO) classifies Burkitt lymphoma into 3 subtypes:
Endemic Burkitt lymphoma
Most commonly affects children in Africa and is linked to Epstein-Barr virus (EBV).
Sporadic Burkitt lymphoma
Commonly found in people of European descent. It makes up around 30% of childhood non Hodgkin lymphoma (NHL) cases.
Immunodeficiency-related Burkitt lymphoma
Affects people with weakened immune systems, such as those with human immunodeficiency virus (HIV).
Diagnosing Burkitt lymphoma
Burkitt lymphoma is diagnosed with a number of tests.
Biopsy
The best test to diagnose Burkitt lymphoma is a biopsy. This may be of a lymph node or a lump. A biopsy is a procedure that involves taking a sample of tissue from a swollen lymph node or a lump and looking at it under the microscope.
Other tests you will have include:
- medical history and physical exam
- blood tests โ full blood count (FBC), kidney and liver function, electrolytes
- genetic tests.
These tests help your treatment team work out how far the disease has spread and what organs are affected.
- computed tomography (CT) scan
- positron emission tomography (PET) scan
- bone marrow biopsy
- lumbar puncture
- magnetic resonance imaging (MRI).
Fertility
Treatments for Burkitt lymphoma can affect fertility. For females some treatments can cause damage to the ovaries. For males it is possible to have low or abnormal sperm production. However, your fertility may become normal again in the future, but it is difficult to predict.
It is important to ask your doctor about your risk of infertility as early as possible. Additionally, there are options for preserving fertility. Therefore, decisions about which options might be right for you usually need to be made before you start treatment.
Go to Fertility support for more information.
Treatment of Burkitt lymphoma
You will need to start treatment for your Burkitt lymphoma right away. It can progress quickly if left untreated.
Your haematologist will consider many factors when discussing a treatment plan with you, including:
- your subtype and stage
- your overall health
- your age
- whether the lymphoma is in your central nervous system (CNS)
- your wishes.
Treatment usually includes chemotherapy, immunotherapy, and steroids. If the disease returns or is hard to treat (refractory), a stem cell transplant may be an option. If the lymphoma has spread to the CNS, you will need lumbar punctures as part of treatment. In some cases, radiotherapy may also be used.
The chemotherapy (chemo) treatment for Burkitt lymphoma is strong and complex. Chemo kills cancer cells and stops them from growing. It also damages healthy cells and causes side effects. You will need to stay in hospital during treatment and recovery to monitor your side effects. There is information on chemotherapy side effects and how to manage them on our chemotherapy webpage.
Treatment plans for Burkitt lymphoma are shortened to letters like DA-R-EPOCH. The letters represent the name of the chemo, steroid and immunotherapy in that plan. Your haematologist will provide you with information on your plan, including when and how often you will have it.
There are several treatment plans for Burkitt lymphoma. They can be found on the Cancer Institute NSW website.
Immunotherapy is a type of biological therapy. It uses the immune system to recognise cancer cells and destroy them. Your treatment team will give this to you via a drip into a vein (intravenous).
Immunotherapy works by:
- stimulating the immune system to find and attack cancer cells
- removing barriers that are stopping the immune system killing cancer cells.
Doctors often give monoclonal antibodies, a type of immunotherapy, along with chemotherapy for Burkitt lymphoma.
Rituximab is a medication that is a monoclonal anti-CD20 antibody, used to treat Burkitt lymphoma.
- Burkitt lymphoma cells carry the CD20 protein on their surface.
- Rituximab connects to the CD20 protein on the cell.
- It damages the cell and causes it to die.
Clinical trials may be available for Burkitt lymphoma. They often compare new or combination therapies with current treatments, including side effects.
Many are randomised, meaning some patients receive the new treatment, and others receive standard care. Trials help improve future treatments and may offer access to costly new therapies not yet on the PBS in Australia.
If you are considering a clinical trial, your doctor will explain:
- the possible risks and benefits
- how it compares to standard treatment
- what is involved.
You will need to give informed consent before taking part.
Trials are voluntary and run through hospitals and clinics. Read more about clinical trials.
Prognosis of Burkitt lymphoma
A prognosis is an estimate your haematologist will make of the likely course and outcome of your disease. Burkitt lymphoma is often curable with intensive treatment.
Your treatment team will consider these factors when discussing your prognosis:
- your subtype and stage
- your overall health
- your age
- whether it is in your central nervous system (CNS).
Your prognosis might change if your Burkitt lymphoma comes back or does not respond to treatment.
Follow-up care for Burkitt lymphoma
You will need regular checkups with your treatment team. This is to check on long term side effects. You will also need tests and scans to make sure the lymphoma hasnโt come back (relapsed/recurred). You will likely need more treatment if the lymphoma returns.
Living with Burkitt lymphoma
How Burkitt lymphoma affects your everyday depends on many factors. It could be that you are returning or managing work, trying to exercise or managing your nutrition. There are some helpful resources and information to guide you on our living well with blood cancer webpage.
Caring for someone with Burkitt lymphoma
We have a range of information and resources that may help when you are caring for someone with Burkitt lymphoma.
Resources for Burkitt lymphoma
Booklets to download:
The non-Hodgkin lymphoma booklet may provide information relevant to anyone diagnosed with Burkitt lymphoma.
The NHL booklet has been translated into the following languages:
