What is multiple myeloma?
Multiple myeloma (plasma cell neoplasms) is a blood disorder that starts in a type of white blood cells called plasma cells. It is the most common type of plasma cell cancer.
Symptoms and signs of multiple myeloma include:
- Bone pain, often in the back, hips and ribs
- Broken bones, often in the spine
- Feeling weak and very tired (often due to anemia or abnormal kidney function)
- Abnormal kidney function, occasionally kidney failure
- Feeling very thirsty (often due to high blood calcium levels)
- Frequent infections and fever
- Nausea or constipation
- Frequent urination
- Weight loss (a rare symptom)
The exact cause of multiple myeloma is unknown.
Amyloidosis is a rare disease that causes the buildup of protein fibers in tissues and organs. Symptoms are similar to myeloma, but may also include:
- Shortness of breath from cardiac disease
- Enlarged tongue
- Gastrointestinal symptoms like abdominal pain and diarrhea
- Liver enlargement and pain
- Abnormal liver and/or kidney function tests
- Easy bruisability
Also known as plasmacytoid or lymphoplasmacytoid lymphoma, Waldenstrom's macroglobulinemia’s symptoms are similar to those of myeloma, except that bone pain and fractures are very rare. Symptoms include:
- Neurological complaints, such as headache
- Abnormal or blurred vision
- Fevers or night sweats
- Enlarged liver, spleen and less commonly, lymph nodes
The risk factors for multiple myeloma may include:
- Middle aged or older
- History of MGUS or plasmacytoma
- Chemicals of a certain type or radiation exposure
Making a correct diagnosis and treatment plan for multiple myeloma can be challenging, but we have the staff and resources to ensure the best possible care. Patients with Waldenstrom's, a disease that bears similarities to both myeloma and non-Hodgkin’s lymphoma, are cared for by experts in both diseases. Expertise in diagnosing and treating myeloma is an essential prerequisite for making crucial distinctions between smoldering multiple myeloma, MGUS and multiple myeloma requiring therapy.
The first step to making a multiple myeloma diagnosis is usually a physical exam, during which a doctor will look for signs of bone pain and tenderness, bruising and anemia. A doctor will also consider the patient’s personal and family medical history. If multiple myeloma is suspected, the patient will be sent for further tests, usually on an outpatient basis. Specialists use a variety of procedures and tests to deliver an accurate multiple myeloma diagnosis, as well as to determine how advanced the cancer is. Tests include:
- X-rays — A skeletal survey X-rays the major bones
- PET/CT (CAT) scan — An imaging technique that can detect areas of growing myeloma cells in the body
- MRI (magnetic resonance imaging) — A powerful magnet, radio waves and computer imaging combine to create highly detailed pictures of areas inside the body
In addition, the laboratory technician does a series of blood and urine tests. These tests document and look for:
- Excessive proteins called immunoglobulins in the blood
- Excessive immunoglobulin levels in the urine
- Anemia, which is identified by low levels of red blood cells
- Whether kidney function is normal (blood creatinine level)
- High levels of calcium in the blood
- A blood marker of myeloma called beta 2 microglobulin
- Any problems with the health of the liver and the patient’s nutritional status, reflected in a blood test called albumin
A bone marrow biopsy will be necessary to establish a conclusive diagnosis of multiple myeloma. To obtain the biopsy, a needle is inserted into the hip bone to get a small piece of bone and bone marrow. Special tests, including flow cytometry, cytogenetics and FISH (fluorescence in-situ hybridization), are used to help determine how likely the myeloma is to respond to treatment.
Standard treatments include:
- Active surveillance—In early-stage myeloma, there are often no symptoms. During this stage, close monitoring of the disease may be recommended without treatment.
- Surgery—In early stage cancer, removal of the tumor and nearby lymph nodes with an endoscope may be all that is required. If the cancer has spread to the outer stomach wall, removal of part or all of the stomach may be required. If a complete removal of the stomach is necessary, the surgeon will attach the esophagus directly to the small intestine.
- Chemotherapy—Chemotherapy may be recommended for the treatment of multiple myeloma. One or more drugs may be used at a time, and chemotherapy may be combined with other types of treatment.
- Radiation therapy—External-beam radiation therapy is sometimes used to treat bone pain associated with multiple myeloma when chemotherapy is not effective in controlling pain. Total body irradiation, a form of radiation therapy may also be used as part of the preparation for a stem cell or bone marrow transplant.
- Targeted therapy—Targeted therapy is a treatment that targets multiple myeloma’s specific genes, proteins or tissue environment that contribute to its growth and survival. Because not all tumors have the same targets, your oncologist may run tests to identify genes, proteins or other factors in your tumor. This can help identify the best treatment possible.
- Stem cell transplantation—For some patients diagnosed with multiple myeloma, a stem cell transplant may be an option. The goal with this treatment is to destroy all the cancer cells in the bone marrow, blood and other parts of the body with a high dose of chemotherapy. Then, replacement blood stem cells are introduced via transfusion, to create new, healthy bone marrow.
Living with multiple myeloma
- Tell your doctor if you are experiencing new pain, or pain that interferes with your daily activities. Do not try to “tough it out.”
- Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. You may get medicine for nausea and vomiting if you have these side effects.
- Eat healthy food. If you do not feel like eating, try to eat food that has protein and extra calories to keep up your strength and prevent weight loss. Drink liquid meal replacements for extra calories and protein. Try to eat your main meal early.
- Get some physical activity every day, but do not get too tired. Keep doing the hobbies you enjoy as your energy allows.
- Take steps to control your stress and workload. Learn relaxation techniques.
- Share your feelings. Stress and tension affect our emotions. By expressing your feelings to others, you may be able to understand and cope with them.
- Consider joining a support group. Talking about a problem with your spouse, a good friend, or other people with similar problems is a good way to reduce tension and stress.
- Express yourself through art. Try writing, crafts, dance, or art to relieve stress. Some dance, writing, or art groups may be available just for people who have cancer.
- Be kind to your body and mind. Getting enough sleep, eating a healthy diet, and taking time to do things you enjoy can contribute to an overall feeling of balance in your life and can help reduce stress.
- Get help if you need it. Discuss your concerns with your doctor or counselor.
- If you are vomiting or have diarrhea:
- Drink plenty of fluids (enough so that your urine is light yellow or clear like water) to prevent dehydration. Choose water and other caffeine-free clear liquids until you feel better. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.
- When you are able to eat, try clear soups, mild foods, and liquids until all symptoms are gone for 12 to 48 hours. Other good choices include dry toast, crackers, cooked cereal, and gelatin dessert, such as Jell-O.
- If you have not already done so, prepare a list of advance directives. Advance directives are instructions to your doctor and family members about what kind of care you want if you become unable to speak or express yourself.