Multiple Myeloma Cancer
Myeloma cancer, also called multiple myeloma, is a type of cancer that starts in your bone marrow. The bone marrow is the soft, spongy center of your bones where blood cells are made. In this cancer, certain cells in the bone marrow, called plasma cells, start growing uncontrollably. These abnormal cells can crowd out healthy blood cells and cause problems in your bones and immune system.
Myeloma can lead to bone pain, fractures, weakness, fatigue, and problems with your kidneys. It’s a serious condition that often requires medical treatment such as chemotherapy, radiation therapy, and medications to manage the disease.
Before diving into specific treatments, it’s essential to understand the goals of myeloma cancer treatment:
- Control the Disease: The primary aim of treatment is to control the growth of myeloma cells and manage symptoms.
- Achieve Remission: Some patients can achieve remission, which means that the cancer is not detectable in the body. Remission can be partial (some cancer remains) or complete (no detectable cancer).
- Prolong Survival: Treatment seeks to extend the patient’s lifespan and improve their quality of life.
- Manage Symptoms: It can cause various symptoms, and treatment helps alleviate pain, weakness, and other issues.
In some cases, if the myeloma cancer is asymptomatic or progressing slowly, the doctor may recommend a period of observation without immediate treatment. Regular check-ups and monitoring of blood tests, imaging, and symptoms will be conducted to track the disease’s progression.
What is Myeloma Cancer?
Multiple myeloma, also known as myeloma, is a type of cancer that originates in plasma cells, a type of white blood cell. Plasma cells are primarily found in the bone marrow, which is the spongy tissue inside the bones. In multiple myeloma, these plasma cells become cancerous and start to multiply uncontrollably.
Normally, plasma cells play a crucial role in the immune system by producing antibodies (also called immunoglobulins) that help fight infections and diseases. However, in multiple myeloma, the cancerous plasma cells produce abnormal and dysfunctional antibodies known as monoclonal proteins, or M proteins.
The excessive growth of these cancerous plasma cells interferes with the production of healthy blood cells, such as red blood cells, white blood cells, and platelets. This can lead to various complications, including anemia (low red blood cell count), increased susceptibility to infections, and problems with blood clotting.
In addition to affecting the bone marrow, multiple myeloma can also cause the following:
- Bone Damage: The excessive growth of cancerous cells in the bone marrow can lead to the weakening and destruction of bones. This can cause bone pain, fractures, and other skeletal problems.
- Kidney Damage: The M proteins produced by myeloma cells can accumulate in the kidneys, leading to kidney damage and impaired kidney function.
- Weakened Immune System: As myeloma cells replace healthy plasma cells, the immune system’s ability to fight infections is compromised.
The exact cause of myeloma cancer is not fully understood, but certain risk factors have been identified, including age (most commonly diagnosed in people over 65), male gender, African or African-American descent, family history of myeloma, exposure to radiation or certain chemicals, and certain pre-existing conditions like MGUS (monoclonal gammopathy of undetermined significance).
Myeloma Cancer Types
Multiple myeloma is the most common type of myeloma cancer. However, there are also other, less common types of this cancer. Here are the different types of myeloma:
- Multiple Myeloma
- This is the most common type of myeloma. It affects plasma cells in the bone marrow and is characterized by the overproduction of abnormal plasma cells. It can cause bone damage, kidney problems, a weakened immune system, anemia, and other complications.
- Smoldering Myeloma
- It is also known as asymptomatic myeloma, which is a less aggressive form of the disease. In smoldering myeloma, abnormal plasma cells are present, but the person does not experience any symptoms or organ damage. It’s often seen as an early stage that may develop into multiple myeloma over time.
- Solitary Plasmacytoma
- Solitary plasmacytoma is a rare type of myeloma where a single tumor or mass of abnormal plasma cells develops in a single bone or soft tissue rather than throughout the bone marrow. It can occur in various parts of the body, such as the bones or respiratory tract. Solitary plasmacytoma may progress to multiple myeloma in some cases.
- Extramedullary Plasmacytoma
- In extramedullary plasmacytoma, cancerous plasma cells form tumors outside the bone marrow. It can occur in soft tissues, such as the nose, throat, gastrointestinal tract, or other organs. EMP is generally a localized condition with a favorable prognosis, but it can occasionally progress to myeloma cancer.
- Non-Secretory Myeloma
- In most cases, the abnormal plasma cells produce M protein, which can be detected through blood tests. However, in non-secretory myeloma, the cancer cells do not produce M protein, making it more challenging to diagnose. Doctors may need to rely on other tests, like bone marrow biopsies or imaging, to confirm this type of illness.
- Light Chain Myeloma (AL Amyloidosis)
- It, also known as AL amyloidosis, is a rare type of myeloma cancer. In this form, the abnormal plasma cells produce light chains, a different type of protein. These light chains can build up in various organs, leading to organ damage and a range of symptoms. AL amyloidosis often requires specialized treatment.
- Immunoglobulin Types
- It can be further categorized based on the type of immunoglobulin (antibody) produced by the abnormal plasma cells. The main types include IgG, IgA, IgD, and IgM myeloma, each having unique characteristics and responses to treatment.
It’s important to note that multiple myeloma is the most prevalent and well-known type of this illness. The other types, such as smoldering, solitary plasmacytoma, immunoglobulin, extramedullary plasmacytoma, etc., are less common and have distinct characteristics and treatment approaches.
Multiple Myeloma Causes
The exact cause of myeloma cancer is unknown. However, researchers have identified several factors that may contribute to the development of multiple myeloma. These factors include:
- Genetic Factors
- Genetics plays a role in myeloma cancer. Some people may inherit genetic mutations that increase their risk of developing the disease. However, it’s important to note that the illness is not directly inherited, like some other genetic conditions. Instead, certain genetic variations may make a person more susceptible to the disease when combined with other factors.
- Age and Gender
- It is more commonly diagnosed in older individuals, with the majority of cases occurring in people over the age of 65. The risk of developing this illness increases with age. Additionally, men have a slightly higher risk of developing the illness compared to women.
- Race and Ethnicity
- Multiple myeloma rates vary among different racial and ethnic groups. African Americans have a higher risk of developing this cancer compared to other racial groups, while Asian Americans and Hispanics have a lower risk.
- Monoclonal Gammopathy of Undetermined Significance (MGUS)
- MGUS is a condition in which abnormal plasma cells produce a small amount of monoclonal protein without causing any symptoms or organ damage. Some cases of this illness may develop from MGUS over time.
- Exposure to Radiation
- Prolonged exposure to high levels of radiation, such as radiation therapy for other cancers, may increase the risk of developing this cancer.
- Exposure to Certain Chemicals
- Occupational exposure to certain chemicals, such as benzene and certain pesticides, has been suggested to potentially increase the risk of the disease, although the evidence is limited and further research is needed.
- Weakened Immune System
- Conditions or treatments that weaken the immune system, such as HIV infection, organ transplantation, or certain medications, may slightly increase the risk of developing the illness. This suggests that a healthy immune system may play a role in preventing the development of the disease.
It’s important to note that while these factors may contribute to the development of myeloma cancer, not all individuals with these risk factors will develop the disease. Similarly, some individuals may develop the disease without any known risk factors. The exact interplay of these factors in the development of this illness is complex and not fully understood.
Myeloma Cancer Symptoms
Multiple myeloma can present with various symptoms. However, it’s important to note that some individuals with this cancer may not experience any symptoms, especially in the early stages of the disease. When symptoms do appear, they can differ from one person to another. Here are some of the most prevalent signs and symptoms of myeloma:
- Bone Pain: Bone pain is one of the most common symptoms of this disease. This pain is often described as a deep ache or discomfort, and it typically occurs in the back, ribs, hips, and skull. The bone pain can be persistent and may worsen with movement or at night.
- Fatigue: Unexplained fatigue or weakness is a frequent symptom of this illness. It can be caused by anemia (low red blood cell count) resulting from the bone marrow’s decreased ability to produce healthy blood cells. Patients may feel unusually tired, have less energy, and find it challenging to perform daily activities.
- Frequent Infections: It weakens the immune system, making it harder for the body to fight off infections. As a result, people with this cancer may experience frequent infections, such as pneumonia or urinary tract infections.
- Kidney Problems: It can harm the kidneys, leading to symptoms like swelling in the legs and ankles, increased thirst, frequent urination, and difficulty urinating. Kidney problems can be serious and require immediate medical attention.
- Bone Fractures: Weakening of the bones due to the disease can increase the risk of fractures. Minor injuries or even normal activities may result in fractures, particularly in the spine or other weight-bearing bones.
- Weight Loss: Unintentional weight loss may occur in individuals with this illness due to a combination of factors, including reduced appetite, changes in metabolism, and the presence of the disease itself.
- Nerve Symptoms: It can cause nerve compression or damage, resulting in symptoms such as numbness, tingling, or weakness in the arms or legs.
- Bleeding and Bruising: It can affect the blood’s ability to clot, leading to excessive bleeding or easy bruising.
- High Calcium Levels (Hypercalcemia): It can cause high levels of calcium in the blood, a condition known as hypercalcemia. Symptoms of hypercalcemia may include excessive thirst, frequent urination, constipation, and confusion.
- Symptoms Related to M Protein: The abnormal plasma cells in this cancer produce a protein called M protein, which can lead to additional symptoms. These may include thickening of the blood, leading to poor circulation, and kidney damage.
- Other Symptoms: Less common symptoms of this illness may include nausea, constipation, increased susceptibility to bleeding gums or nosebleeds, shortness of breath, and cognitive changes.
It’s important to remember that these symptoms can also be caused by conditions other than this illness. If you or someone you know experiences persistent bone pain, weakness, fatigue, frequent infections, or any of the other symptoms mentioned here, it’s important to seek medical attention. Early detection and appropriate medical management can significantly improve the condition of individuals with this illness.
Multiple Myeloma Diagnosis
The diagnosis of myeloma cancer typically involves a combination of medical history evaluation, physical examination, laboratory tests, imaging studies, and a bone marrow biopsy. Here are the common steps involved in the diagnosis of myeloma:
- Medical History and Physical Examination: The journey to a myeloma diagnosis often begins with a visit to a doctor. During this initial visit, the doctor will conduct a physical examination and ask about the patient’s medical history. They’ll look for signs and symptoms that may suggest that you are affected by this illness, such as bone pain, weakness, fatigue, and frequent infections.
- Blood Tests: Blood tests play a crucial role in multiple myeloma diagnoses. Doctors will typically order a series of blood tests, including:
- Complete Blood Count (CBC): This test measures the number of different blood cells, such as red blood cells, white blood cells, and platelets. The disease can affect these levels.
- Blood Chemistry Profile: This test assesses various substances in the blood, including calcium levels, kidney function, and protein levels. Elevated calcium or abnormal protein levels may indicate myeloma cancer.
- Serum Protein Electrophoresis (SPEP) and Urine Protein Electrophoresis (UPEP): These tests identify abnormal proteins in the blood and urine, including the M protein produced by myeloma cells.
- Urine Tests: Urine tests may be done to check for abnormal proteins or Bence Jones proteins, which are a type of abnormal protein sometimes found in the urine of individuals with the illness.
- Imaging Studies: Imaging studies help visualize the bones and tissues and can reveal any abnormalities. Common imaging tests used in myeloma diagnosis include:
- X-rays: These can show bone damage or fractures caused by the disease.
- Computed Tomography (CT) Scans: CT scans provide detailed cross-sectional images of the body, helping doctors assess bone and soft tissue abnormalities.
- Magnetic Resonance Imaging (MRI): MRIs offer a more detailed view of the bone marrow and soft tissues, helping doctors evaluate the extent of myeloma involvement.
- Positron Emission Tomography (PET): PET scans help doctors see multiple myeloma better. They use special pictures to show where the cancer is and how active it is. PET scans find the disease earlier than regular tests, so doctors can plan treatment sooner. They also help track if the treatment is working or if the cancer is getting worse. PET scans give clear information, so doctors can make better choices for treating myeloma cancer and improve a person’s chances of getting better.
- Bone Marrow Biopsy and Aspiration: A bone marrow biopsy is a crucial test for diagnosing the disease. It involves extracting a small sample of bone marrow and examining it under a microscope to assess the presence of abnormal plasma cells and determine their percentage in the marrow. This procedure is usually performed on the back of the hip bone using a special needle.
- Genetic and Cytogenetic Testing: Genetic tests, such as fluorescence in situ hybridization (FISH) or cytogenetic analysis, may be performed on the bone marrow sample to identify specific genetic abnormalities associated with the disease, such as changes in chromosomes or gene mutations. These tests can provide important prognostic information and guide treatment decisions.
Once the diagnosis of multiple myeloma is confirmed, further tests may be performed to stage the disease, assess organ function, and determine the extent of bone damage. Staging helps determine the prognosis and guide treatment planning.
Myeloma Cancer Treatment
Treatment for myeloma cancer often involves a combination of therapies tailored to the patient’s specific situation. Here are the common treatment options for myeloma:
- Chemotherapy: Chemotherapy involves using medications to kill or control the growth of cancer cells. It may be given in combination with other drugs and is often administered in cycles to allow the body time to recover between treatments.
- Stem Cell Transplantation: Stem cell transplantation, also known as a bone marrow transplant, may be considered for eligible patients, especially younger individuals who are in good overall health. In this treatment, damaged bone marrow is replaced with healthy stem cells. First, doctors collect the patient’s stem cells or use a donor’s. Then, high-dose chemotherapy is given to kill cancer cells. After that, the healthy stem cells are put back into the body to make new blood cells. This helps fight the cancer and rebuild the immune system. Stem cell transplantation can offer a chance for remission or better control of multiple myeloma.
- Targeted Therapy: Targeted therapy is a specialized treatment approach that focuses on specific molecules (such as proteins) within cancer cells to inhibit their growth and spread. Unlike chemotherapy, which affects healthy cells too, targeted therapy is more precise, causing fewer side effects. By blocking specific pathways that drive cancer growth, targeted therapies can help slow the progression of myeloma cancer and improve patient conditions. These therapies are often used in combination with other treatments to enhance their effectiveness. Examples of targeted therapies for the disease include proteasome inhibitors (such as bortezomib and carfilzomib), immunomodulatory drugs (such as lenalidomide and pomalidomide), and monoclonal antibodies (such as daratumumab and elotuzumab).
- Immunotherapy: Immunotherapy helps stimulate the body’s immune system to recognize and destroy myeloma cells. Examples of immunotherapy used in the treatment include monoclonal antibodies, CAR-T cell therapy, and immune checkpoint inhibitors. These therapies target cancer cells and enhance the immune response against them. By stimulating the immune system, immunotherapy can help control multiple myeloma and extend remission periods.
- Radiation Therapy: Radiation may be used to target and destroy cancer cells, especially when they are causing pain or threatening vital organs.
Supportive care plays a crucial role in managing multiple myeloma and its associated symptoms. This may include medications to manage pain, prevent infections, treat anemia, and support kidney function. Supportive therapies may also include bisphosphonates to help reduce bone loss and the risk of fractures. It also addresses the emotional and psychological aspects of living with cancer.
Myeloma cancer treatment often involves a team of healthcare professionals, including hematologists, oncologists, nurses, and other specialists. This multidisciplinary approach ensures that patients suffering from this illness receive comprehensive care.
Treatment decisions are made on an individual basis, and the specific treatment plan will be determined by the healthcare team in collaboration with the patient. Regular follow-up visits and monitoring are important to assess treatment response, manage side effects, and adjust the treatment plan as needed.
It’s important to consult with a hematologist or oncologist who specializes in treating the disease to discuss treatment options, potential side effects, and the overall management plan. They will provide personalized guidance based on your specific situation.
In conclusion, myeloma is a type of blood cancer that starts in the bone marrow and affects the production of vital blood cells. Although it can lead to various health problems, advancements in medical science offer hope for improved treatments and better outcomes for those living with multiple myeloma. Early diagnosis and medical care remain crucial in the fight against this disease.
- Cancer.org: https://www.cancer.org/cancer/types/multiple-myeloma/about/what-is-multiple-myeloma.html