Multiple Myeloma Symptoms, Causes And Treatment

Myeloma is a type of cancer that affects plasma cells, also called multiple myeloma because of its tendency to develop at multiple places in the bone marrow. Plasma cells are derived from B lymphocytes and are responsible for producing antibodies. Antibodies are proteins made by our body to fight the disease carrying germs and other foreign particles.

Read more on what is blood cancer here.

Visual representation of cancer cells affecting the body

In myeloma, the plasma cells multiply rapidly and uncontrollably. This crowds the bone marrow where blood cells are produced as the cancerous cells multiply faster, and as a result, the production of normal blood cells declines. The plasma cells can develop into a tumour too, when the tumour is formed at a single isolated location it is called plasmacytoma and if it develops at several locations, it is called multiple myeloma.

Myeloma accounts to 1.8% of the total cancer cases globally and 30,000 new cases are estimated for the year 2018. This amounts to about 6.7 cases per 100,000 people based on the data from 2011 to 2015.

Symptoms:

The following are a few symptoms to look out for in case of myeloma.

1.Low blood counts:

Low counts of red blood cells, white blood cells and platelets in the blood as the production of cells is decreased. The patient may be more prone to catch infections easily as a consequence of decreased white blood cells. The fall in the platelet count results in abnormal bleeding and bruising and wounds take longer to heal. Anemia, a condition where the red blood cells count is low leads to breathlessness and tiredness.

2.Bone pains:

The presence of plasma cells in large numbers damages the bones causing dull and aching pain in the bones, often in the lower back or ribs.

3.Excess calcium:

Damage to the bones in our body signals the release of calcium into the bloodstream, a condition called hypercalcemia. This has the symptoms of feeling very thirsty, frequent urination, dehydration, and can even cause kidney damage. Lack of appetite, severe constipation, feeling drowsy, weak or confused may also be noticed.

4.Kidney damage:

Excess calcium in the body can also affect the kidneys. In addition to that, cancer affected cells continue to produce antibodies similar to healthy cells. But the antibodies produced, called monoclonal proteins or M proteins are dysfunctional and harm our bodies rather than fight against infections. These M proteins lead to kidney damage too.

Risk factors:

Factors which can cause a certain disease are called its risk factors. Read on the risk factors for blood cancer {insert secondary article hyperlink}. Note that existence of risk factors is not an indicative of the disease itself but that it is more probable in those cases. Myeloma is rare under the age of 40 and the risk increases with age, it is also more common in men than in women. The risk factors of myeloma are as follows:

1.Monoclonal Gammopathy of Undetermined Significance (MGUS):

A rare condition in which large protein molecules called immunoglobulins are present in excess. MGUS is not harmful on its own, it does not cause any symptoms or affect one’s health too much. It is a condition often discovered as it can be detected through routine blood tests too. It is considered as a precancerous condition as it can in certain cases develop into myeloma, regular checkups and tests are advisable in case of MGUS.

2.Myeloma in the family history:

Myeloma in parents or siblings showed two to three times more likelihood of developing myeloma than when compared to people with no family history of the disease.

3.Lowered immunity:

In cases like organ transplant, immunosuppression medication is given to decrease the patient’s immunity for the body to accept the treatment. While it may be essential in such cases, the fact remains that the risk of myeloma increases and care and constant attention is needed to avoid complications. People with HIV have increased risk of myeloma.

4.Autoimmune conditions:

Autoimmune conditions are those in which the immune system which protects the body from attacks, damages it instead. Pernicious anaemia,ankylosing spondylitis, autoimmune haemolytic anaemia, systemic lupus erythematosus, etc. are come autoimmune conditions that increase the risk of myeloma. Gaucher’s disease, a rare genetic condition, also has increased risk.

5.Past exposure to radiation:

Like most forms of cancer, exposure to radiation increases the risk of the disease even in myeloma. The cells becoming cancerous in nature can be due to mutation of genes that can happen on prolonged or intense exposure of radiation.

Stages:

There are two major conventions of staging myeloma and both of them give three stages of the disease but take different factors into consideration. They are:
International Staging System: In this, the stages are marked by the levels of albumin and microglobulin in the blood. This system is based on more than 10,000 cancer cases.
Durie-Salmon Staging: This system marks the stages depending on several factors- level of cancerous cells, damaged caused to the bone, levels of M protein, calcium levels in the blood, albumin and hemoglobin levels. Also, there is further classification based on whether or not there is kidney damage (Group A indicating normal kidney function, B indicating abnormality, for example: Stage IA)

Types:

There are several classification based on several factors- the stage of myeloma, the symptoms shown by the patient, the presence of symptoms itself, etc. Here are a few to indicate the terminology surrounding the types of myeloma.

1.Asymptomatic and symptomatic:

As the name suggests, in asymptomatic, the patient shows no symptoms in terms of damaging the body. The cancer can be stable at this stage or advance further into symptomatic myeloma. Asymptomatic is also called smoldering or indolent myeloma. Symptomatic myeloma is active and shows significant damage to the organs

2.Hyperdiploid and Hypodiploid:

Another type of classification, based on the chromosome number in the myeloma cells. Hyperdiploid indicates that myeloma cells have more chromosomes than normal and there are less chromosomes in hypodiploid myeloma when compared to normal. Hyperdiploid is less aggressive than hypodiploid.

Detection:

Multiple Myeloma can be detected by the following techniques.

  • The presence of M proteins in the body by blood or urine tests.
  • Biopsy of the bone marrow or the tumour and testing the cells for cancer.
  • Holes in the bones or other secondary cancers imaging tests can confirm or deny the presence of this cancer too.

Treatment:

The treatment for myeloma depends on the stage and type of cancer and the patient’s symptoms.The major treatment methods for myeloma are:

  1. Chemotherapy
  2. Steroids
  3. Biological therapy are the major treatments for myeloma
  4. Stem cell transplant is an option too.

A single treatment method or a combination of those is used to treat the disease depending on the local of the myeloma.

Survival rates:

The survival rate is usually measured by the five year survival rate, which denotes the number of people out of 100 who live beyond five years after being diagnosed with the cancer. The overall five year survival rate for myeloma is 50.7%. The survival rate depends on whether the cancer is localized or has spread (metastasized). It is about 72% in case of localized cancer but only about 5% of the total myeloma cases are localized. The metastasized cases account to 95% of total cases and the survival rate for these is around 50% only.

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