Epstein-Barr virus and cancer
Epstein-Barr virus (EBV), also known as human herpesvirus 4, is one of the eight types of human herpesviruses and is primarily transmitted through saliva. It is widely recognized for its association with infectious mononucleosis, a condition characterized by fever, sore throat, and swollen lymph nodes. Beyond its role in infectious mononucleosis, EBV is considered a carcinogenic virus linked to various cancers, particularly Burkitt lymphoma and nasopharyngeal carcinoma. The virus can establish a lifelong dormant presence in the body and may reactivate, especially in individuals with weakened immune systems, such as those undergoing immunosuppression or living with HIV/AIDS.
Globally, the prevalence of EBV varies, with over 90% of adults in the United States being infected, while many children in developing regions are exposed at a much younger age. The incidence of certain EBV-related cancers, such as Burkitt lymphoma, has been increasing, particularly in regions where malaria is endemic, as this can compromise the immune system. Symptoms of related cancers can include swollen lymph nodes, weight loss, and breathing difficulties. Due to its widespread impact, understanding the connection between EBV and cancer is crucial for public health, especially in populations at risk.
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Epstein-Barr virus and cancer
ALSO KNOWN AS: EBV, human herpesvirus 4 (HHV-4)
RELATED CANCERS: Burkitt lymphoma, non-Hodgkin (NHL), Hodgkin lymphoma, nasopharyngeal carcinoma, infectious mononucleosis
DEFINITION: Epstein-Barr virus is one of the eight known types of human herpesviruses and is a member of the gamma subtype of this group. Like many herpesvirus species, Epstein-Barr virus appears to establish a lifelong presence in the human body, remaining quiescent for long periods and then inexplicably becoming active. Causally related to mononucleosis, it is also associated with various human cancers, such as Burkitt lymphoma and nasopharyngeal carcinoma, and is, therefore, considered a carcinogenic virus.
Exposure routes: Humans are the only known reservoir of Epstein-Barr virus, which is present in oropharyngeal secretions and is most commonly transmitted through saliva. Transmission of the virus requires intimate contact with the saliva (found in the mouth) of an infected person. Transmission through the air or blood does not usually occur. Epstein-Barr virus is causally related to infectious mononucleosis (IM), a disease characterized by the proliferation of single-nucleus white blood cells, resulting in fever, sore throat, and sometimes hepatitis. Infectious mononucleosis may be contagious for weeks. However, isolation measures are impractical since the Epstein-Barr virus is frequently present in the saliva of healthy persons, who may carry and spread the virus intermittently. Transmission of the Epstein-Barr virus is, therefore, practically impossible to prevent.
Where found: Over 90 percent of adult Americans are infected with the Epstein-Barr virus, but it is less prevalent in children and teenagers—a pattern observed in the developed world but not in developing regions. In Africa, for example, most children have been infected by the virus by age three. Epstein-Barr virus has also been associated with nasopharyngeal cancers in Asia (especially China) and Burkitt lymphoma in equatorial Africa and Papua New Guinea. In tropical regions, Burkitt lymphoma coexists with malaria. In the United States, the Epstein-Barr virus has also been associated with nasopharyngeal cancers in immigrants from Asia. The incidence of Burkitt lymphoma has been increasing. Non-Hodgkin lymphomas are found in people whose immune systems have been compromised by drug therapy and disease.
At risk: Epstein-Barr virus has been shown to take advantage of those with weakened immune systems. Burkitt lymphoma, a non-Hodgkin lymphoma (NHL), is found in organ transplant patients undergoing immunosuppression therapy, as well as those living with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) who are immunocompromised by their disease. Burkitt lymphoma typically occurs in tropical climates where malaria is endemic, which compromises individuals’ immune systems and fosters tumor production. Epstein-Barr virus is also associated with nasopharyngeal carcinoma, which is prevalent in those of Chinese ancestry. Genetic and environmental factors, such as a diet high in nitrosamines, may also contribute to cancer development. Environmental or occupational exposure to pesticides and solvents shows no significant pattern of positive association with Epstein-Barr virus and related cancers.
Etiology and symptoms of associated cancers: Epstein-Barr virus is among the most ubiquitous of viruses, and most people will become infected with Epstein-Barr virus. In the United States, as soon as maternal antibodies disappear, infants become vulnerable to Epstein-Barr virus infection. In adolescents, infection with the Epstein-Barr virus results in infectious mononucleosis in at least 25 percent of cases. Although the symptoms of infectious mononucleosis usually dissipate within several months, the Epstein-Barr virus lies dormant in a few cells in the throat and blood for the remainder of the person’s life. Occasionally, the virus may reactivate and is often present in the saliva, suppressing the immune system by causing repeated mutations in B cells, which may proliferate unabated, resulting in tumors.
Epstein-Barr virus establishes a lifelong latent infection in the body’s immune system that may later result in the emergence of Burkitt lymphoma and nasopharyngeal carcinoma. The initial symptoms of Burkitt lymphoma may include a swollen lymph node in the upper body or abdomen. If the tumor is in the chest, breathing difficulties may ensue. Itching, weight loss, fever, and fatigue may occur in others. Commonly, Burkitt lymphoma forms a large tumor mass in the jawbone. Adults with AIDS often develop tumors in various parts of the body. Symptoms of nasopharyngeal cancer may include a lump in the neck or nose, numbness on the side of the face, headaches, ear pain, and difficulty speaking and breathing.
History: In the late nineteenth and early twentieth century, the American and European medical communities began reporting a novel syndrome of fever, sore throat, and swollen glands, later termed mononucleosis and causally related to the Epstein-Barr virus. The Epstein-Barr virus was discovered in the 1960s from a biopsy of a tumor associated with Burkitt lymphoma. It was the first virus directly linked to human cancer. In 1964, Michael Epstein and Yvonne Barr isolated virus particles from cell lines derived from Burkitt lymphoma, hence the name Epstein-Barr virus. Subsequently, the Epstein-Barr virus was found to be the leading viral cause of cancer in humans, having an etiological role in Burkitt lymphoma and other B-cell lymphomas, as well as nasopharyngeal carcinoma.
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