Multiple Myeloma Cancer

Multiple myeloma is a type of cancer that occurs when abnormal plasma cells are produced in the bone marrow and begin to multiply rapidly. These cancerous myeloma cells eventually outgrow the production of healthy bone marrow cells.

These malignant myeloma cells produce abnormal antibodies called monoclonal (M) proteins, which can damage the kidneys and cause other serious health issues.

Multiple myeloma is a rare disease. In the United States, the National Cancer Institute estimated that 34,920 new cases of multiple myeloma would occur in 2021, accounting for about 1.8% of all new cancer cases.

In this article, we’ll discuss the symptoms, causes, types, and treatments of multiple myeloma.

Types of Multiple Myeloma

1. Indolent Myeloma:
   This type typically grows slowly and may show no symptoms. It does not usually form bone tumors but may slightly increase M protein and plasma cells.

2. Solitary Plasmacytoma:
   Usually forms a single tumor in the bone. It responds well to treatment, but close monitoring is necessary.

Symptoms of Multiple Myeloma

Symptoms vary from person to person. In early stages, there may be no noticeable symptoms. But as the disease progresses, most patients experience at least one of the four major signs — commonly referred to as CRAB:

• C = Elevated Calcium levels

• R = Renal failure (Kidney failure)

• A = Anemia (Low red blood cell count)

• B = Bone damage

Common Early Symptoms

• Bone pain (especially in the back or chest)

• Fatigue

• Nausea

Symptoms of High Calcium Levels

When bones are damaged, calcium may leak into the bloodstream, causing:

• Excessive thirst

• Nausea

• Vomiting

• Constipation

• Loss of appetite

• Confusion

Symptoms of Kidney Failure

High levels of M protein can damage the kidneys:

• Reduced urine output

• Swelling in feet, ankles, or legs

• Shortness of breath

• Fatigue

• Persistent nausea

• Confusion

• Chest pain

• Fever

• Coma

Symptoms of Anemia

When cancer cells suppress healthy blood cell production:

• Fatigue

• Dizziness

• Irritability

Symptoms of Bone Damage

When cancer spreads to the bones:

• Pain in the back, hips, ribs, or skull

• Fractures with little trauma

Other Possible Symptoms

• Numbness or weakness in limbs

• Unexplained weight loss

• Repeated infections

• Vision problems

• Urination issues

Causes & Risk Factors

The exact cause of multiple myeloma is unknown. It typically starts from one abnormal plasma cell that grows uncontrollably and does not die off like normal cells. This disrupts the body’s balance and reduces healthy cell production.

Risk Factors Include:

• Male gender

• Age 50 or older

• African American ethnicity

• Obesity

• Exposure to radiation

• Working in the petroleum industry

• MGUS (Monoclonal Gammopathy of Undetermined Significance) — a non-cancerous condition that can develop into multiple myeloma over time

Diagnosis of Multiple Myeloma

Doctors may detect signs of myeloma even without symptoms, often through routine blood or urine tests. If detected, further testing is done to determine disease progression and need for treatment.

Blood and Urine Tests

• Detection of M protein

• Beta-2 microglobulin level (a cancer marker)

• Kidney function

• Blood cell count

• Calcium and uric acid levels

Imaging Tests

Used to check for bone damage:

• X-rays

• MRI

• CT scans

• PET scans

Bone Marrow Biopsy

A small sample of bone marrow is examined for cancerous plasma cells and their abnormal growth characteristics.

Related Plasma Cell Disorders

1. MGUS: Produces excess M protein, usually harmless but requires monitoring.

2. Solitary Plasmacytoma: Plasma cells are localized to a single tumor.

3. Light Chain Amyloidosis: Abnormal proteins build up in organs like the kidneys or heart.

4. Waldenstrom Macroglobulinemia: A rare cancer that overproduces IgM, thickening the blood and impairing organ function.

Staging of Multiple Myeloma

After diagnosis, doctors determine the stage of the disease based on:

• Blood cell counts

• Protein levels in blood/urine

• Calcium levels

Two Major Staging Systems:

1. Durie-Salmon System — Based on M protein, calcium levels, anemia, and bone damage.

2. International Staging System (ISS) — Based on beta-2 microglobulin and albumin levels.

Both divide the disease into three stages, with stage 3 being the most advanced.

Treatment Options

There is no permanent cure for multiple myeloma, but treatment can relieve symptoms, slow progression, and improve quality of life. Treatment is usually started when symptoms appear or the disease progresses.

1. Targeted Therapy

Disrupts cancer cell proteins, causing them to die.
Drugs: Bortezomib (Velcade), Carfilzomib (Kyprolis)

2. Biological Therapy

Boosts the immune system to fight myeloma cells.
Drugs: Thalidomide, Lenalidomide (Revlimid), Pomalidomide

3. Chemotherapy

High-dose drugs destroy rapidly dividing cancer cells.
Used before stem cell transplant.
Drugs are given via IV or as pills.

4. Corticosteroids

Reduce inflammation and kill myeloma cells.
Drugs: Prednisone, Dexamethasone

5. Radiation Therapy

Uses high-energy beams to kill cancer cells. Often used for isolated tumors causing pain.

6. Stem Cell Transplant

Replaces diseased bone marrow with healthy stem cells (from self or donor).
Usually follows high-dose chemo or radiation.

7. Complementary Medicine

Not a primary treatment, but may relieve symptoms.
Includes acupuncture, aromatherapy, massage, meditation.
Always consult a doctor before trying these.

Managing Complications

• Back pain: Painkillers or back brace

• Kidney issues: Dialysis or transplant

• Infections: Antibiotics

• Bone loss: Medications to slow it down

• Anemia: Drugs like erythropoietin to increase red blood cells

Living with Multiple Myeloma

• Get informed: Learn about your condition and discuss with your doctor.

• Build support: Lean on family, friends, and support groups.

• Set realistic goals: Don’t overexert yourself.

• Maintain a healthy lifestyle: Eat well, sleep adequately, and do light exercise regularly.

Prognosis and Life Expectancy

After diagnosis, some people may remain symptom-free for several years. When symptoms develop, many respond well to treatment.

Median survival times:

• Stage 1: ~5 years (62 months)

• Stage 2: ~3–4 years (44 months)

• Stage 3: ~2–3 years (29 months)

These are estimates — actual outcomes vary by individual. Your doctor is the best person to advise on your specific condition.