Multiple Myeloma

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

Blood tests

Urine tests

Bone marrow aspiration

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:

  1. 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.
  2. 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.
  3. 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.
  4. 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.
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