Lymph node cancer

Acknowledged as one of the fastest growing tumours, Burkitt’s lymphoma is a rare but dangerous cancer that kills instantly if left untreated. However, the cancer which commonly affects people in the tropical region, easily responds to drugs (intensive chemotherapy) once detected early.
Twenty four-year-old Moses Echodu shares his experience of surviving a childhood episode of Burkitt’s Lymphoma.

REAL LIFE EXPERIENCE
“It started as a limp in my left leg back in 1998 when I was only eight years old. Before, I was a normal child who had a passion for football. When one day my leg could not touch the ground properly, I thought I had I injured it while playing football.
I used to live with my grandmother in Adachar- Katakwi District and when she saw this, she took me to a nearby clinic in Usuku village. I was given fever treatment but after two weeks, the limping persisted and this time, it was coupled with dizziness.
My mother Sally Opus, then living in Kampala where she was pursuing her studies, came to pick me from my grandmother who had briefed her about my situation. I was then taken to Nsambya Hospital where I had to undergo an X-ray to ascertain what was wrong with me,” narrates Echodu.
“After the X-ray examination, the doctor found out that his fifth vertebrae had been eaten up by something unusual. He was then operated upon by a doctor who cut part of his rib to mend the rotten part,” says Ms Opus.
“After the operation, the doctors said there was something odd about my son’s situation so they took some sample cells for a biopsy examination which was only done in Mulago at that time. While we waited for the biopsy results, my son would cry all the time with intense pain and could not even walk. After three weeks, the biopsy results showed my son had a cancer called Burkitt’s lymphoma and this was more evident because he had grown a tumour in the neck,” Echodu’s mother recalls.
We were then referred to Uganda Cancer Institute in Mulago where we would get the right treatment since there was a specific unit for such children.
Each small bottle of Vincristine (the drug we used to buy) would go for Shs50,000 and he needed about eight doses. Spending Shs400, 000 for only medicine was very costly for me because there were other expenses,” explains Opus.
“After three months, I was discharged from Mulago Hospital but as a side effect to the drugs the doctor administered, I was paralyzed and could not walk. I was just crawling. I felt sad because I thought I had to forget about football and that I would never play normally like a child,” Echodu remembers.
Echodu’s mother recounts how she used to lift her son like a baby from Kitintale where they lived with her brother to bring him to Mulago for weekly checks and reviews. “I wanted him to get better because the doctor had told me he would walk again,” she recalls .
Echodu was then started on intensive physiotherapy such as ball rolling and massages, though initially, he felt all these were not working. He had to put his heart into the exercises because they were his only hope. Slowly his body started to respond. After a year of physiotherapy, he started to walk but with the support of crutches. He later resumed school but still on crutches.
“In 2002, the doctor told me I had recovered from the cancer but I had to go for annual cancer tests. The tendons in my legs had become so stiff that I had to undergo another operation to relieve the tendons.
I then continued with physiotherapy and a year later, I was able to walk on my own and play like other children,” recalls Echodu.

EXPERT’S SAY

Burkitt’s lymphoma is a cancer that affects the lymph nodes. Lymph nodes store white blood cells which are part of the body’s defense system. Therefore, anything that affects them disturbs the body’s immune system.
The cancer usually manifests as a rapidly growing tumour in the neck or jaw. The cause of Burkitt’s lymphoma is not known but is associated with a viral infection known as Epstein-Barr virus (EBV) especially in the case of the Endemic (native) type of Burkitt’s lymphoma. This cancer was named after Dr Denis Burkitt who first discovered a case in Africa in the 1950’s. This virus is usually supported by Malaria and HIV which weaken the body’s immune system.
“We get 500 new cases of child cancers at the institute every year and Burkitt’s lymphoma accounts for 23 per cent with 2-3 cases being referred to the institute monthly,” says Dr Fadhil Gerige, a paediatrician and oncologist at Uganda Cancer Institute in Mulago Hospital.

SIGNS AND SYMPTOMS

Burkitt’s lymphoma is one of the fastest growing human tumours. The disease can be fatal if left untreated. Fortunately, once detected, it responds quickly to intensive chemotherapy. Some of the cancer symptoms include;

Swollen jaw and loose teeth
High fever and night sweating
Swelling in the neck, abdomen, bone
Headaches and inability to concentrate
Abdominal pain
Shortened breaths
Loss of weight

TYPES OF LYMPHOMA

Endemic Burkitt’s lymphoma (African)
This is the commonest type in Uganda and more pronounced in the tropical belt. It was first discovered in Uganda in the 1950’s by Dr Denis Burkitt and hence the name. It is a childhood cancer which affects children between 6-7 years. The child develops a rapidly growing tumour within a gestation period of two months.

HIV-related Burkitt’s
This affects people with HIV/AIDS and cuts across all age groups. This type of Burkitt’s lymphoma is common worldwide.

Sporadic Burkitt’s
This type of Burkitt’s lymphoma is common among people in the western world and can affect everyone. Although it is rare, Dr. Gerige says it one of the fastest growing cancers.

“Very few people know about Burkitt’s lymphoma including lower level health workers. When children develop swollen jaws, they are often mistaken to have tooth problems and sometimes parents associate it to witchcraft,” the medical officer adds.

The institute has organised outreach programmes through its initiative Comprehensive Community Cancer Programme where they educate people on the various types of cancer, their signs and symptoms and advise people to go for tests.

DIAGNOSIS

“A biopsy must be done by a pathologist to prove the presence of the cancer. This is because several diseases may have similar signs and symptoms. Here, a small part of the suspected cells is cut and taken in the laboratory to be examined,” says Dr Gerige.
Then there are several tests that Burkitt’s lymphoma patient must udergo, including a chest x-ray examination and bone marrow biopsy.
Vulnerable groups
Everyone, both young and old, can be affected by Burkitt’s lymphoma. However, two thirds of adults affected by the cancer are male and in children, more boys than girls suffer from this cancer.
Myths and misconceptions
“We fail to manage some of the Burkitt’s lymphoma cases because parents associate it to witchcraft or tooth problems and by the time they come to hospital, it is already too late for us to reverse some of the complications which are usually permanent,” Dr Gerige says.

A cancer misunderstood
“We fail to manage some of the Burkitt’s Lymphoma cases because parents associate it with witchcraft or tooth problems and by the time they come to hospital, it is already too late for us to reverse some of the complications which are usually permanent.”

Dr Fadhil Gerige, a paediatrician and oncologist at Uganda Cancer Institute in Mulago Hospital.

COMPLICATIONS

The most immediate result of Burkitt’s Lymphoma is death.
Since the cancer affects the spinal cord and the brain, a child is more likely to become lame, unable to control their bowels, unable to swallow food properly due to the tumour that develops in the neck and may lead to blindness.

Dr. Gerige says, “All these complications can be reversed if the cancer is detected and reported early. However, we are only able to cure 70 percent of these cancers and the 30 per cent are brought when the cancer is its latest stages and then we cannot do too much.”

Treatment
In many African societies, once a person is diagnosed with cancer, they feel it is the end of the world and all they do is wait for their dying date. There has not been enough awareness among the population and many relatives have not supported cancer patients.

Dr. Gerige says everyone should get involved in fighting cancer through carrying out advocacy campaigns and health education, to ensuring survival through good treatment as well as psychosocial support from family members.

“Unlike some cancers that may not be curable, Burkitt’s Lymphoma is the first ever known cancer to be cured by chemotherapy only,” says Dr Gerige. He adds that a person should have continuous checks until the cancer is ruled out.
“However, we get challenges because there has not been enough public education and thus 30 percent of the cases are reported in the latest stages which we fail to manage so we end up losing those children.”