诊断
Burkitt lymphoma diagnosis often begins with a physical exam that checks for swollen lymph nodes and a neurological exam, which tests how well the brain and nerves are working. Other tests and procedures might include blood tests, imaging tests and taking a sample of tissue for lab testing.
Blood tests
Blood tests can sometimes show whether lymphoma cells are present. Blood tests also measure levels of lactate dehydrogenase (LDH). This enzyme is often higher in people with lymphoma. Blood tests also can check for infections that may increase the risk of Burkitt lymphoma, such as Epstein-Barr virus and HIV.
Imaging tests
Imaging tests make pictures of the body. They can show the location and extent of Burkitt lymphoma. Tests might include CT and positron emission tomography (PET) scans. Your healthcare team also may do an MRI if they think the cancer is affecting the central nervous system.
Lymph node biopsy
Your healthcare professional may suggest a lymph node biopsy to look for cancer cells. A biopsy is a procedure to remove a sample of tissue for testing in a lab. A lymph node biopsy involves removing all or part of a lymph node. In the lab, tests may show whether you have Burkitt lymphoma.
Bone marrow aspiration and biopsy
Bone marrow aspiration and biopsy are procedures to collect cells from the bone marrow for testing. Bone marrow is the soft matter inside bones where blood cells are made. Bone marrow has a solid part and a liquid part.
In a bone marrow aspiration, a needle is used to draw a sample of the fluid. In a bone marrow biopsy, a needle is used to collect a small amount of the solid tissue. The samples are typically taken from the hip bone. The samples go to a lab for testing. In Burkitt lymphoma, this procedure is done to help determine the cancer's extent.
Lumbar puncture
A lumbar puncture is a procedure to collect fluid from around the spinal cord. A lumbar puncture, also called a spinal tap, is done using a needle. A healthcare professional inserts the needle between two bones in the lower back and draws out some of the fluid that surrounds the brain and spinal cord. This fluid is called cerebrospinal fluid. The fluid goes to a lab where it's tested for cancer cells.
For Burkitt lymphoma, a lumbar puncture may be done if you have any neurological symptoms. It also may be done if you are at higher risk of lymphoma of the central nervous system.
Testing lymphoma cells in the lab
Lymphoma cells collected from a lymph node biopsy or bone marrow aspiration and biopsy go to a lab for testing. In the lab, specialized tests look for specific things about the cells. The healthcare team uses the results to decide on the type of lymphoma that you have.
To decide whether the cells are Burkitt lymphoma cells, the healthcare professionals in the lab look for:
- How the cells look under a microscope. The cancer causes changes in the tissue that makes it look a certain way when viewed with a microscope. Healthcare professionals sometimes say the tissue looks like a "starry sky."
- Proteins inside and on the surface of the cancer cells. Burkitt lymphoma cells can be identified by the presence of certain proteins on the surface or inside the cell. These proteins are known as markers. The marker Ki-67, found inside the cell, shows up in very high levels in Burkitt lymphoma. Common markers found on the surface of Burkitt lymphoma cells are CD10, CD19, CD20, CD79a, CD22, CD38 and CD45. Burkitt lymphoma also can be diagnosed by the absence of certain proteins, including BCL2, CD44 and TdT.
- Changes in the cancer cell DNA. Cancer happens when cells get changes in their DNA. A cell's DNA holds the instructions that tell the cell what to do. In Burkitt lymphoma, the cells have a gene change that causes their DNA to rearrange. This is known as translocation. This gene change causes the cells to multiply rapidly. MYC is the gene linked to Burkitt lymphoma.
Burkitt lymphoma staging
If you're diagnosed with Burkitt lymphoma, the next step is to determine the extent of the cancer, called the stage. Imaging tests, blood tests and biopsies may be used to determine the stage of your Burkitt lymphoma. Your healthcare team uses the cancer stage to help create your treatment plan.
The stages of Burkitt lymphoma range from 1 to 4:
- Stage 1 Burkitt lymphoma. A stage 1 Burkitt lymphoma means only one lymph node region or one site outside of the lymph nodes is affected.
- Stage 2 Burkitt lymphoma. A stage 2 Burkitt lymphoma involves two or more lymph node regions on the same side of the diaphragm.
- Stage 3 Burkitt lymphoma. A stage 3 Burkitt lymphoma involves lymph node regions on both sides of the diaphragm.
- Stage 4 Burkitt lymphoma. A stage 4 Burkitt lymphoma involves regions outside of the lymph nodes.
Burkitt lymphoma prognosis
The cancer prognosis tells you how likely it is that the cancer can be controlled. Your healthcare team can get a general sense of your outlook using your Burkitt lymphoma stage. But the stage can't tell your future. Your personal prognosis may depend on:
- Your age.
- Your overall health.
- The cancer's stage.
- Lymph node and bone marrow biopsy results.
Talk with your healthcare team about your prognosis if you want to know what to expect. Your healthcare team can explain what is considered when thinking about your prognosis.
Burkitt lymphoma survival rates
Burkitt lymphoma survival rates depend on several factors, including the stage, what treatments are used and if the central nervous system is involved. In children, survival rates are often above 90% when treated right away. This is especially true in children with stage 1 or stage 2 cancer that hasn't spread. In adults, the survival rates range from 50% to 90% depending on overall health.
治疗
Burkitt lymphoma is typically treated with a combination of chemotherapy medicines. Burkitt lymphoma may be cured if treated right away. Other treatments may include chemotherapy, immunotherapy, clinical trials, bone marrow transplant, also called stem cell transplant, and radiation therapy. Which treatment is best for you depends on the extent of your cancer, called the stage. Your healthcare team also considers how quickly the cancer is growing, your overall health and what you prefer.
Chemotherapy
Chemotherapy treats cancer with strong medicines. There are many chemotherapy medicines. Most chemotherapy medicines are given through a vein. Some come in pill form.
Chemotherapy is often the first treatment used for Burkitt lymphoma. Several chemotherapy medicines may be used at once. Chemotherapy may be combined with immunotherapy. Other medicines may be used at the same time to protect the central nervous system. Chemotherapy also may be used in people whose cancer has come back after treatment, called relapsed Burkitt lymphoma. In people with HIV, medicines called antiretrovirals may be given during or after chemotherapy treatment.
Immunotherapy
Immunotherapy for cancer is a treatment with medicine that helps the body's immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells.
Immunotherapy may be used as a first line treatment for Burkitt lymphoma. It is often combined with chemotherapy. Immunotherapy also may be combined with other medicines in people with advanced cancer or cancer that has come back after treatment, known as relapsed Burkitt lymphoma.
Clinical trials
Clinical trials are studies of new treatments. These studies provide a chance to try the latest treatments. The risk of side effects might not be known. Ask your healthcare team if you might be able to be in a clinical trial.
Clinical trials are often used to treat Burkitt lymphoma that has come back after treatment, known as relapsed Burkitt lymphoma. They also may be used to treat Burkitt lymphoma that hasn't responded to other treatments, known as refractory Burkitt lymphoma.
Bone marrow transplant
A bone marrow transplant, also called a bone marrow stem cell transplant, involves putting healthy bone marrow stem cells into the body. These cells replace cells hurt by chemotherapy and other treatments.
Stem cells can come from your own body, called an autologous transplant, or from a donor, called an allogeneic transplant. A stem cell transplant may be an option for some people whose cancer has returned after a long period of remission.
Radiation therapy
Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources. During radiation therapy, you lie on a table while a machine moves around you. The machine directs radiation to precise points on your body.
Radiation therapy may be used for advanced Burkitt lymphoma to relieve symptoms and improve quality of life. This is known as palliative radiation therapy.
Monitoring after treatment
After treatment is complete, you may have frequent follow-up appointments to see if the cancer has come back, known as a relapse. For Burkitt lymphoma, most relapses happen in the first year after treatment. You may have repeat blood and imaging tests and, if needed, biopsies, to check for relapse.
Side effects of treatment
Treatments for Burkitt lymphoma may have side effects. These may include nausea, vomiting, fatigue, fever, rash, diarrhea and more. Harmful side effects from treatments may include:
- Bone marrow suppression. When the bone marrow is suppressed, it can't produce enough blood cells, including white blood cells. White blood cells help fight infections, so with a lower amount you are at a higher risk of infections.
- Febrile neutropenia. Febrile neutropenia is a serious condition that can happen in people being treated for cancer. Febrile means having a fever. Neutropenia means having a low number of neutrophils, which are a type of white blood cell that helps fight infections. In febrile neutropenia, the body is trying to fight an infection but doesn't have enough neutrophils.
- Medicine toxicity. Some medicines used to treat cancer can be harmful to the body. They can cause organ damage and other issues. Whether a medicine is toxic depends on the type and how much you take. There are many different medicine options, so your healthcare team can work with you to find the best medicines for you.
- Tumor lysis syndrome. Tumor lysis syndrome is a serious condition that can happen when cancer cells break down quickly after treatment. When these cells die, they release substances into the bloodstream that can overwhelm the body. This can lead to issues with the kidneys and other organs. Medicines may be given to treat or prevent harmful side effects.
妥善处理与支持
With time, you'll find what helps you cope with the uncertainty and worry of a cancer diagnosis. Until then, you may find it helps to:
Learn enough about Burkitt lymphoma to make decisions about your care
Ask your healthcare team about your cancer, including your test results, treatment options and, if you want, your prognosis. As you learn more about Burkitt lymphoma, you may become more confident in making treatment decisions.
Keep friends and family close
Keeping your close relationships strong can help you deal with Burkitt lymphoma. Friends and family can provide the practical support you may need, such as helping take care of your home if you're in the hospital. And they can serve as emotional support when you feel overwhelmed by having cancer.
Find someone to talk with
Find someone who is willing to listen to you talk about your hopes and worries. This may be a friend or family member. The concern and understanding of a counselor, medical social worker, clergy member or cancer support group also may be helpful.
Ask your healthcare team about support groups in your area. Other sources of information include the National Cancer Institute, the American Cancer Society, the Leukemia & Lymphoma Society and the Lymphoma Research Foundation.
准备您的预约
Make an appointment with a doctor or other healthcare professional if you have any symptoms that worry you.
If your healthcare professional thinks you might have Burkitt lymphoma, you may be referred to a doctor who specializes in diseases that affect blood cells, called a hematologist. If a cancer diagnosis is made, you also may be referred to a doctor who specializes in treating cancer, called an oncologist.
Because appointments can be brief, it's a good idea to be prepared. Here's some information to help you get ready.
What you can do
- Be aware of anything you need to do ahead of time. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
- Write down symptoms you have, including any that may not seem related to the reason for which you scheduled the appointment.
- Write down important personal information, including major stresses or recent life changes.
- Make a list of all medicines, vitamins and supplements you're taking and the doses.
- Take a family member or friend along. It can be hard to remember all the information you get during an appointment. Someone who goes with you may remember something that you missed or forgot.
- Write down questions to ask your healthcare team.
Your time with your healthcare team is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For Burkitt lymphoma, some basic questions to ask include:
- Do I have Burkitt lymphoma?
- What is the stage of my Burkitt lymphoma?
- Has my Burkitt lymphoma spread to other parts of my body?
- Will I need more tests?
- What are the treatment options?
- What are the potential side effects of each treatment?
- How will each treatment affect my daily life?
- Is there one treatment option you believe is the best?
- What would you recommend to a friend or family member in my situation?
- Should I see a specialist?
- Are there any brochures or other printed material that I can take with me? What websites do you recommend?
- What will determine whether I should plan for a follow-up visit?
Don't hesitate to ask other questions.
What to expect from your doctor
Be prepared to answer questions, such as:
- When did your symptoms begin?
- Do your symptoms happen all the time or do you have them now and then?
- How bad are your symptoms?
- What, if anything, seems to make symptoms better?
- What, if anything, seems to worsen your symptoms?
- Have you had any fevers, night sweats or weight loss?
- Have you noticed any lumps, swelling or pain anywhere in your body?
- Have you had any recent infections?
- Do you have any other health conditions, such as diabetes, heart disease or kidney disease?
- What are your biggest worries about your diagnosis or treatment?