What Is Multiple Myeloma?
Multiple myeloma is cancer that affects certain white blood cells called plasma cells. It represents about one percent of all cancers in the United States. Approximately four to five out of every 100,000 people are diagnosed with it each year.
How Does Multiple Myeloma Develop?
The human body is made up of tiny building blocks called cells. Normal cells grow and multiply when the body needs them, and die out when the body does not need them.
Cancer is made up of abnormal cells that grow whether or not the body needs them. Multiple myeloma is cancer that begins in the plasma cells, a type of white blood cell. Plasma cells make proteins that help the body fight disease. These cells are in the soft inner part of our bones, called the bone marrow. Multiple myeloma starts when plasma cells become abnormal. It’s also known as myeloma or plasma cell myeloma.
Effects of Multiple Myeloma
White blood cells originate in the bone marrow, some of which become antibody-producing plasma cells.
Cancerous plasma cells are called myeloma cells. Myeloma cells crowd normal bone marrow, so there is not enough room for the bone marrow to make as many healthy cells. Several kinds of blood problems may result.
- Low red blood cell count. This condition is called anemia. We diagnose anemia through a blood test. Anemia can cause tiredness as well as other problems.
- Low white blood cell count. This condition is neutropenia. It weakens the body’s defenses against infection.
- Low platelet count. This condition is called thrombocytopenia. It may lead to bleeding. Although this cancer starts in blood cells, it also affects the bones. Myeloma cells can harm the bone structure. Bones may become weak and more likely to break.
Multiple Myeloma and Hypercalcemia
Because they destroy bone, myeloma cells can cause the calcium that’s stored in the bone to be released into the bloodstream. This can lead to too much calcium in the blood, called hypercalcemia. Hypercalcemia can harm the heart, nerves and kidneys. Signs of hypercalcemia include:
- Constipation
- Fatigue
- Frequent urination
- Frequent thirst
- Muscle weakness
Multiple Myeloma and Kidney Function
Myeloma can also affect the kidney. Myeloma cells make large amounts of abnormal proteins called M-proteins. These M-proteins circulate in the blood and can overwork the kidneys, so they cannot function properly.
Multiple Myeloma Symptoms
Symptoms of multiple myeloma include bone pain, weakness and weight loss.
Multiple Myeloma Risk Factors
We don’t know what causes multiple myeloma, but there are certain risk factors that make you more likely to develop the disease. Risk factors include family history, your age and a history of plasma cell disease.
Multiple Myeloma Diagnosis
We may use a number of different tests to confirm a diagnosis of multiple myeloma. These include X-ray, MRI and bone marrow aspiration biopsy.
Multiple Myeloma Symptoms
The symptoms of multiple myeloma may resemble other bone disorders or medical problems. Always consult your doctor for a diagnosis.
Each individual may experience symptoms differently. Myeloma cells and antibodies may cause symptoms including:
- Bone pain
- Fractures in bones
- Weakness
- Fatigue
- Weight loss
- Repeated infections
- Nausea
- Vomiting
- Constipation
- Problems with urination
- Weakness or numbness in legs
- Back pain
- Rib pain
Multiple Myeloma Diagnosis
If you experience any of the above symptoms, we will order a number of different tests to confirm a diagnosis, including imaging scans and a biopsy.
Diagnosing Multiple Myeloma
Sometimes, we find myeloma during a routine visit, even if you don’t have symptoms. If you’re having symptoms of multiple myeloma, your doctor will ask you about:
- Your health history
- Your family’s history of cancer
- Your other risk factors
We may also perform certain tests to check if you have multiple myeloma. You may need more than one of these tests:
X-ray
What Are X-rays?
An X-ray is a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
X-rays use invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs on film. Standard X-rays are performed for many reasons, including diagnosing tumors or bone injuries.
X-rays are made by using external radiation to produce images of the body, its organs, and other internal structures for diagnostic purposes. X-rays pass through body structures onto specially-treated plates (similar to camera film) and a “negative” type picture is made (the more solid a structure is, the whiter it appears on the film).
When the body undergoes X-rays, different parts of the body allow varying amounts of the X-ray beams to pass through. The soft tissues in the body (such as blood, skin, fat, and muscle) allow most of the X-ray to pass through and appear dark gray on the film. A bone or a tumor, which is more dense than the soft tissues, allows few of the X-rays to pass through and appears white on the X-ray. At a break in a bone, the X-ray beam passes through the broken area and appears as a dark line in the white bone.
Radiation during pregnancy may lead to birth defects. Always tell your radiologist or doctor if you suspect you may be pregnant.
X-rays help the doctor see if any of your bones are broken or affected, which is a sign of multiple myeloma.
Blood tests
What Is a Blood Test?
Your evaluation may include the performance of specific blood tests, including (but not limited to) cell counts, measurement of various blood chemistries and markers of inflammation. We can measure many things in your blood such as salts, blood cell counts and protein markers specific to the heart (one is called BNP). Additional tests may include blood chemistries, evaluation of liver and kidney functions, and genetic studies). In some cases, genetic testing may be recommended. In addition, we may ask you to join our ongoing studies by allowing us to collect and store some of your blood for future analysis.
Blood tests help your doctor check your immunoglobulin (antibody) levels. These are the proteins made by plasma cells. Multiple myeloma causes an increase in M protein (immunoglobulin) levels. Your doctor will also take a small sample of your blood for a complete blood count (CBC) and a comprehensive metabolic panel. This will let your doctor check for anemia, hypercalcemia, kidney injury and other problems that may result from multiple myeloma.
Urine tests
Urinalysis
Urinalysis is a laboratory examination of urine for various cells and chemicals, such as red blood cells, white blood cells, infection, or excessive protein. Urinalysis breaks down the components of urine to check for the presence of drugs, blood, protein, and other substances. Blood in the urine (hematuria) may be the result of a benign (noncancerous) condition, but it can also indicate an infection or other problem. High levels of protein in the urine (proteinuria) may indicate a kidney or cardiovascular problem.
Urine tests can help your doctor check for M protein and other protein levels. You may need to collect your urine for 24 hours for these tests. These tests may also show how well your kidneys are functioning. Myeloma can harm your kidneys.
Bone marrow aspiration
Bone Marrow Aspiration and Biopsy
Bone marrow aspiration and biopsy involves the removal of bone marrow, blood, and a small piece of bone by inserting a needle into the hipbone or breastbone. This type of biopsy is performed either from the sternum (breastbone) or the iliac crest hipbone (the bone area on either side of the pelvis on the lower back area). The skin is cleansed and a local anesthetic is given to numb the area. A long, rigid needle is inserted into the marrow, and cells are aspirated for study; this step is occasionally uncomfortable. A pathologist views the bone marrow, blood, and bone under a microscope to look for signs of cancer. A core biopsy (removing a small bone ‘chip’ from the marrow) may follow the aspiration.
These tests look for cancer cells in the bone marrow, usually in the hip bone. They are often done at the same time. The area over the hip is first numbed with a local anesthetic. For the bone marrow aspiration, the doctor places a thin, hollow needle attached to a syringe into your hip bone to suck out (aspirate) a sample of blood and cells from the bone marrow. This is usually followed by the bone marrow biopsy. For the biopsy, the doctor uses a larger needle to remove a small piece of bone and bone marrow from your hip bone. A pathologist then checks the cell samples for cancer. A pathologist is a doctor who specializes in looking at cells under a microscope to check for problems, including cancer. A biopsy is the only way for your doctor to know for sure if you have cancer.
MRI
Magnetic Resonance Imaging (MRI)
MRIs use radio waves and magnets to create images of the inside of your body. The energy from the radio waves creates patterns formed by different types of tissue and diseases. These patterns make cross-sectional pictures that look like slices of the body. If you are having a lot of pain at a certain spot, your doctor may order an MRI of your spine or a particular area of the bone, such as your hip bone. Your doctor may also use this test to find out if a damaged area of your spine or bones is at risk for more damage from the myeloma.
For this test, you lie still on a table as it passes through a tubelike scanner. The scanner directs a continuous beam of radio waves at the area being examined. A computer uses data from the radio waves to create pictures of the inside of your body. You may need more than one set of images. Each one may take 2 to 15 minutes. This test may last an hour or more. Ask for earplugs if they aren’t offered since there is a loud thumping noise during the scan. If you are claustrophobic, you may be given a sedative before having this test.
CT scan
Computerized Tomography (CT Scan)
A CT scanner takes many X-rays as you slide through it on a table. A computer combines these images to create detailed pictures that your doctor can view. CT scans can show early stages of bone involvement with multiple myeloma.
PET scan
Positron Emission Tomography (PET Scan)
Your doctor may also schedule a positron emission tomography (PET) scan to help determine your stage. This test scans your entire body, so it is more helpful than a series of several different X-rays. The PET scan shows which parts of your body are using glucose rapidly. Glucose use is a sign of active, quickly dividing cells, such as multiple myeloma cells. For this test, you get injected with a small amount of radioactive glucose. Then you lie still on a table that is pushed into the PET scanner, which rotates around you, taking pictures.
Multiple Myeloma Treatment
Once we confirm a diagnosis, we will tailor a treatment plan that meets your needs. Your specific treatment will depend on many factors, including your age, general health and severity of your condition.
Multiple Myeloma Staging
Before we decide on treatment options, we will need to know the extent, or stage, of the multiple myeloma. We will look at the results of blood tests, imaging tests and bone marrow tests to determine the stage of the cancer. Once we determine the stage, we can plan the most effective treatment for multiple myeloma.
There are two systems to stage multiple myeloma:
Durie-Salmon System of Staging
The Durie-Salmon system is the traditional system used to stage multiple myeloma. It is based on four different factors:
- The amount of abnormal monoclonal immunoglobulin in the blood or urine. A large amount of monoclonal immunoglobulin is a sign that many malignant plasma cells are in the blood making this abnormal protein.
- The amount of calcium in the blood. High blood calcium levels are also related to advanced bone damage. Bone normally contains a lot of calcium and bone destruction releases calcium into the blood.
- The amount of bone damage seen on X-rays. If there are many areas of bone damage, that is a sign of an advanced stage of multiple myeloma.
- The amount of hemoglobin in the blood. Hemoglobin is the part of the red blood cell that carries oxygen. Low hemoglobin levels are a sign that the myeloma cells are taking up much of the bone marrow, and there is not enough space left for the normal marrow cells that make red blood cells.
Stages in the Durie-Salmon System
There are three different clinical stages of multiple myeloma in the Durie-Salmon system. Stage I indicates the smallest amount of tumor. Stage III indicates the largest amount of tumor.
- Stage I: X-rays and blood tests indicate that only a small number of myeloma cells are present in the body. Most people with this stage do not have symptoms. Your doctor may say that you have a “low tumor burden” at this stage.
- Stage II: The myeloma cells have spread through the body a little bit. Your doctor may say that you have an “intermediate tumor burden” at this stage.
- Stage III: X-rays and blood tests indicate that many cancer cells are present in the body. Your doctor may say that you have a “high tumor burden” at this stage.
International Staging System
The International Staging System is a newer system now used by many doctors to classify multiple myeloma. This system divides myelomas into three stages based only on the blood levels of beta-2 microglobulin and albumin.
- Stage I: The beta-2 microglobulin level is less than 3.5 milligrams/liter (mg/L) and the albumin level is 3.5 grams/deciliter (g/dL) grams or higher.
- Stage II: Neither stage I or III, meaning that either:
- The beta-2 microglobulin level is between 3.5 and 5.5 (with any albumin level), or
- The albumin is below 3.5 while the beta-2 microglobulin is less than 3.5
- Stage III: The beta-2 microglobulin level is greater than 5.5.
