Health care professionals often find multiple myeloma when they are testing for another illness. The M proteins myeloma cells make can show up in blood and urine tests.
Something in plasma cells (a type of white blood cell) makes them change into cancerous myeloma cells. They build up in the bone marrow and cause problems with bones, kidneys, and blood.
Diagnosis
To diagnose multiple myeloma, your healthcare provider will do a physical exam and ask about your symptoms. They will also check your family medical history. Then they will do a blood test to see how many plasma cells are in your body. They will also look for certain proteins made by plasma cells that aren’t healthy. These proteins can cause different health problems, including anemia (low levels of red blood cells that carry oxygen to the rest of your body). These abnormal plasma cells can also crowd out healthy white blood cells that fight infections.
These blood tests may also find a protein called beta-2 microglobulin in your blood, which myeloma cells make. Your doctor may also do other blood tests to see how well your kidneys and bones are working. They may also order a complete blood count (CBC) with a differential to measure the numbers of different types of blood cells in your body. They may order a test to check your creatine level, albumin levels and calcium levels. They might also order a test to look for monoclonal proteins in your blood and urine, such as Bence Jones proteins.
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Your healthcare provider might order an MRI or CT scan to see if there are any tumors or other damage to your bones or organs. These scans use magnetic fields and radio waves instead of x-rays. They can show a more detailed picture of your body than standard X-rays. They can also show whether your bones are breaking down or getting thinner (osteoporosis).
If a tumor is found, your healthcare provider might order a bone marrow biopsy to find out what type of plasma cell is causing the cancer and to learn its stage. They might also order a positron emission tomography (PET) scan, which uses small amounts of radioactive tracers that are swallowed or injected and then absorbed by the body to create pictures of your internal structures, such as your bones, liver and kidneys. This type of scan can show active cancer cells or cancer cells that have died.
Symptoms
Plasma cells are a type of white blood cell that help your immune system fight infections. They make proteins called antibodies that find and attack germs. In multiple myeloma, cancerous plasma cells build up in the bone marrow, the soft matter inside bones where blood cells are made. The cancer cells crowd out healthy plasma cells, which are unable to make enough antibodies to fight infection. The abnormal plasma cells also produce substances that damage and weaken the bones.
Symptoms of multiple myeloma depend on the stage of the disease. Early-stage plasma cell neoplasms, such as MGUS and smoldering myeloma, often do not cause symptoms. These slow-growing myelomas do not need treatment right away, but healthcare providers monitor these patients closely. They may start treatment later if the myeloma progresses.
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Some symptoms of multiple myeloma include bone pain, especially in the back and ribs. Fatigue and shortness of breath are common. Myeloma can also lead to anemia, a condition in which you have too few red blood cells to carry oxygen throughout your body.
A weakened immune system can result in more frequent infections and may delay your recovery from illness. Some people with multiple myeloma develop kidney damage. The cancerous plasma cells can clog the kidneys and prevent them from filtering wastes out of the body, leading to high calcium levels in the blood and other problems.
Other symptoms of multiple myeloma can include tingling in your hands and feet, low blood count (anemia), and confusion. High calcium levels in the blood and kidney failure can also cause changes in appetite, weight loss and nausea. People with myeloma are more likely to have other health conditions, such as high blood pressure, heart problems and diabetes. This is why it is important to tell your doctor about any symptoms you have and follow up with regular appointments. Your doctor can check your overall health and refer you to a specialist if needed. Symptoms of myeloma and other health conditions can be treated with medicines, tests, radiation therapy and surgery. Treatment can improve your quality of life and prolong survival.
Treatment
The treatment plan for multiple myeloma depends on several things, including the stage of the disease and your symptoms. Research has improved the prognosis (the prediction of how fast your disease will grow and whether it will get worse) for people with myeloma, and doctors now have many effective treatments to improve quality of life for patients.
The first step in treatment is to try to put the cancer into remission. Your doctor will prescribe medicines to reduce the number of plasma cells and prevent them from growing. They may also give you chemotherapy medicines to kill the cancer cells.
These drugs include melphalan, cyclophosphamide, thalidomide and dexamethasone. They can be given by mouth, vein or injection into a muscle. A stem cell transplant can also help to cure multiple myeloma, but only if your plasma cells are still in remission at the time of the transplant.
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If your myeloma recurs after treatment, you have relapsed. Your doctor may repeat the initial high-dose chemotherapy regimen, or give you other chemotherapy medicines, such as lenalidomide, pomalidomide or carfilzomib, along with bortezomib and dexamethasone, or a different type of stem cell transplant. They may also prescribe maintenance therapy with medicines such as Revlimid, Velcade or Ninlaro, alone or in combination.
Other tests can help find out how much myeloma is in your body. For example, a healthcare provider will use a needle to remove a sample of bone marrow to check the numbers of abnormal plasma cells. They may also do a skeletal bone survey using x-rays to see which bones are damaged. They can also do a computed tomography scan, magnetic resonance imaging (MRI), or positron emission tomography (PET) test to look for single groups of plasma cells called plasmacytomas.
Blood tests can measure the amount of calcium in your blood, which is important because too much can damage the kidneys and heart. They can also measure the levels of beta-2-microglobulin and albumin in your blood. These proteins keep fluid from leaking out of cells and carry nutrients, hormones, vitamins, drugs and calcium throughout the body.
Prevention
A variety of factors can increase the chance that multiple myeloma will develop, but there are no ways to prevent it. The disease affects infection-fighting plasma cells that live in the bone marrow, so it is difficult to predict who will get it. The most common risk factor for this cancer is having a first-degree relative with it, including a parent or sibling. This cancer also tends to run in families, so researchers are looking into whether myeloma has a genetic component. Other risk factors include age, being black and having monoclonal gammopathy of undetermined significance (MGUS), which is a precursor to multiple myeloma. People who have smoldering MGUS have a two- to fourfold higher risk of developing active multiple myeloma.
Because plasma cells are involved in making antibodies, people with myeloma often have low white blood cell counts and are at increased risk for infections. They should talk to their doctors about immunizations, particularly pneumococcal pneumonia and influenza (flu) vaccines. In addition, they should consider getting the pneumococcal conjugate vaccine.
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This is a newer vaccine that is being studied to see if it can help prevent myeloma. It binds to the cancer cells and interferes with their ability to bind to and enter healthy cells, blocking them from attaching and spreading throughout the body.
It is important to discuss any unusual symptoms with your doctor, especially pain, weakness and fatigue, and a change in urine or stool color. A doctor can diagnose the cause of these symptoms and refer you to a specialist, such as a hematologist/oncologist.
Although no preventive measures are available, there are things you can do to help stay healthy. Eat a balanced diet and be physically active. Maintaining a normal body weight helps lower the risk of osteoporosis, which can lead to fractures and bone pain. Avoid smoking and exposure to chemicals, such as herbicides, pesticides, petroleum products, heavy metals and plastics. These chemicals can damage the immune system and lead to cancer. Getting enough sleep and rest also helps. Having support systems can also be helpful.