Burkitt Lymphoma in Children

What is Burkitt lymphoma in children?

Burkitt lymphoma is a rare, fast-growing form of non-Hodgkin lymphoma (NHL). It’s a type of cancer of the lymphatic system. The lymphatic system is part of the immune system. It helps to fight diseases and infections. The lymphatic system also helps with balancing fluids in different parts of the body. The lymphatic system includes:

  • Lymph. This is a fluid that contains lymphocyte cells.
  • Lymph vessels. These are tiny tubes that carry lymph fluid throughout the body.
  • Lymphocytes. These are a type of white blood cells that fight infections and disease. Burkitt lymphoma grows from B-cells, one type of lymphocyte.
  • Lymph nodes. These are small bean-shaped organs. They are in the underarm, groin, neck, chest, abdomen, and other parts of the body. 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. And it 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. This type causes large tumors of the face and jaw.
  • Sporadic (non-endemic). This type occurs in the U.S. and Western Europe. It is more common in Caucasian people. This type often causes large tumors in the belly (abdomen).
  • Immunodeficiency-associated. This type mostly affects those with HIV infection. The lymph nodes, bone marrow, and brain and spinal cord (central nervous system) are often affected.

Which children are at risk for Burkitt lymphoma?

In children, Burkitt lymphoma is more common in boys between 5 and 10 years of age.

What causes Burkitt lymphoma in a child?

Like other types of NHL, the exact cause of Burkitt lymphoma is not known. Genes and 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, the virus that causes mono (mononucleosis)
  • HIV, the virus that causes AIDS

What are the symptoms of Burkitt lymphoma in a child?

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
  • Nausea and vomiting
  • Fever
  • Trouble with bowel movements (constipation)
  • Poor appetite

Other symptoms may include:

  • Painless swelling of the lymph nodes in neck, chest, abdomen, underarm, or groin
  • Fever
  • Sore throat
  • Bone and joint pain
  • Night sweats
  • Tiring easily (fatigue)
  • Weight loss
  • Poor appetite
  • Itching of the skin
  • Recurring infections

The symptoms of Burkitt lymphoma can look like other health conditions. Make sure your child sees a healthcare provider for a diagnosis.

How is Burkitt lymphoma diagnosed in a child?

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 have tests such as:

  • Blood and urine tests. Blood and urine are tested in a lab.
  • Tissue biopsy. A sample is taken of the tumor, lymph nodes, or other tissue. It’s checked with a microscope for cancer cells.
  • Chest X-ray. The chest X-ray shows the heart, lungs, and other parts of the chest. 
  • CT scan. This may be done for the abdomen, chest, and pelvis. A CT scan uses a series of X-rays and a computer to make detailed pictures of the body.
  • MRI scan. An MRI uses large magnets, radio waves, and a computer to make detailed pictures 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 unclear. 
  • Ultrasound. This is also called sonography. Sound waves and a computer are used to make pictures of blood vessels, tissues, and organs.
  • Positron emission tomography (PET) scan. For this test, a radioactive sugar is injected into the bloodstream. Cancer cells use more sugar than normal cells, so the sugar will collect in cancer cells. A special camera is used to see where the radioactive sugar is in the body. A PET scan can sometimes spot cancer cells in different areas of the body, even when they can’t be seen by other tests. This test is often used in combination with a CT scan. This is called a PET/CT scan.
  • 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. This is called aspiration. Or solid bone marrow tissue may be taken. This is called a core biopsy. Bone marrow is usually taken from the hip bone. This test may be done to see if cancer cells have reached the bone marrow.
  • Lumbar puncture. A special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. This is done to check the brain and spinal cord for cancer cells. A small amount of cerebral spinal fluid (CSF) is removed and sent for testing. CSF is the fluid around the brain and spinal cord.
  • Peritoneal fluid sampling. Fluid is removed from the belly (peritoneum). The fluid is checked for cancer cells.

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 the treatment. There are different ways of staging used for Burkitt lymphoma. Talk with your child’s healthcare provider about the stage of your child’s cancer. One method of staging Burkitt lymphoma is the following:

  • Stage I. The lymphoma is in only 1 place. It’s either in a lymph node or one other part of the body. It is not in the chest or abdomen. 
  • Stage II. The lymphoma is in 2 or more places. It’s all in either the upper or lower part of the body. It’s not in the chest. 
  • Stage III. The lymphoma is in the chest or spine, or it has spread throughout the abdomen. Or it is both in the upper and lower parts of the body, but is not in bone marrow or the brain or spinal cord (central nervous system).
  • Stage IV. The lymphoma is in the bone marrow, the brain and spinal cord, or all three when it is first found.

How is Burkitt lymphoma treated in a child?

Treatment will depend on the type and stage. Burkitt lymphoma is usually treated with:

  • Chemotherapy medicines. These are powerful medicines that work to stop the growth of cancer cells. Usually more than one type of medicine is used. The medicines are usually given into a vein (IV). Other forms of chemotherapy may be given as a pill, a shot (injection) in a muscle, or injected into the spinal fluid. 
  • Surgery. Surgery may be done to remove a large belly (abdominal) tumor. This may be 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. 

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
  • Look for returning or spreading cancer

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.

What are possible complications of Burkitt lymphoma in a child?

Possible complications depend on the type and stage of the lymphoma, and can include:

  • Increased risk of infection
  • Heart disease
  • Lung problems
  • Increased chance of growing other cancers
  • Trouble reproducing (infertility)
  • Death

Treatment may also cause complications. They include:

  • Increased risk of bleeding
  • Increased risk for infection
  • Nausea and vomiting
  • Diarrhea
  • Poor appetite
  • Sores in the mouth
  • Hair loss

How can I help my child live with Burkitt lymphoma?

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.
  • If your child smokes, help him or her quit. If your child doesn’t smoke, make sure he or she knows the danger of smoking.
  • Get emotional support for your child. Find a counselor or child support group can help.
  • Make sure your child attends all follow-up appointments.

When should I call my child’s healthcare provider?

Call the healthcare provider if your child has:

  • Symptoms that get worse
  • New symptoms
  • Side effects from treatment

Key points about Burkitt lymphoma in children?

  • Burkitt lymphoma is a very fast-growing type of non-Hodgkin lymphoma.
  • It often causes large belly (abdominal) tumors.
  • A child will have swollen lymph nodes, tiredness, fever, and other symptoms.
  • Treatment may include chemotherapy and surgery.
  • With treatment, most children with Burkitt lymphoma go on to live long lives.

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.

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