Three cancer types have their awareness month in March: Colon and Kidney cancer, plus Multiple Myeloma. Today we’ll look at Multiple Myeloma.
Multiple Myeloma’s awareness colour is burgundy – a colour we don’t stock! Do you think we should? Drop us a line!
The ‘multiple’ in this cancer’s name can be a bit scary, but myeloma can be highly manageable, and understanding it is the first step.
It’s a blood cancer that develops in plasma cells in the bone marrow, soft, spongy tissue at the centre of bones. In healthy bone marrow, normal plasma cells make antibodies to protect the body from infection. In multiple myeloma, plasma cells are transformed into cancerous cells that grow out of control, crowding out the normal ones. These malignant plasma cells then produce an abnormal antibody, M protein which, in high levels, is characteristic of multiple myeloma.
There is no exact identified cause, but in recent years, researchers have gained a better understanding of how multiple myeloma develops. Like all cancers, multiple myeloma takes many forms, so each case is unique. Multiple myeloma is caused by certain genetic mutations, which differ from person to person. Yet while certain mutations have been identified as risk factors, multiple myeloma is not thought to be a hereditary disease. It has been shown to occur more often in males of African descent aged over 45—and studies are continuing to provide new information on other myeloma risk factors.
As mentioned, when myeloma cells multiply in the bone marrow, they crowd out normal cells, meaning that there is less room for—and fewer—red blood cells, white blood cells, and platelets. Fewer blood cells can cause anemia, excessive bleeding, and diminished ability to fight infection. As the amount of M protein rises in the blood and urine it can damage the kidneys and other organs.
Myeloma cells may activate other cells in the marrow that can damage bones, which can cause bone pain and weakened spots on bones, called osteolytic lesions. This bone damage increases the risk of fractures and can also lead to increased levels of calcium in the blood, or hypercalcemia.
Multiple myeloma symptoms vary from person to person. Often, in the early stages of disease, there are no obvious symptoms. Even when they are present, symptoms may be vague or similar to those of other conditions. Several different urine and blood tests are used to confirm the diagnosis.
Decreased production of red blood cells can result in anemia, as can some multiple myeloma treatments. Anemia is typically defined as an abnormally low level of hemoglobin (Hb), which is found in red blood cells and carries oxygen from the lungs to the tissues in the body.
Anemia can cause weakness, fatigue, shortness of breath, and dizziness. Over 60% of multiple myeloma patients have anemia at the time they are diagnosed. Most patients become anemic at some point of their disease.
The anemia can be treated through supplementation with iron, folate, or vitamin B12 and treatment with red blood cell growth factors. In severe cases, blood transfusions may be needed.
The low white blood cell count caused by multiple myeloma also damages the immune system as white blood cells play an important role in fighting off infection.
Although multiple myeloma leads to an increased level of antibodies, these are ineffective, and the multiple myeloma cells crowd out the healthy cells that produce functional, disease-fighting antibodies.
An impaired immune system lessens the body’s ability to prevent or fight off infections, making people with multiple myeloma more susceptible to infections – 15 times more likely than those without the disease.
It’s important to reduce the risk of infection. These include regular hand washing, washing fresh produce, avoiding contact with people who show signs of being sick, protecting the skin from scrapes and cuts, keeping up to date with recommended vaccines such as flu, COVID, pneumonia, and shingles. Medication can further reduce risk of infection.
Consult your doctor in case of symptoms of infection: high fever, chills or sweating, muscle aches, coughing, sore throat, pain/redness around an open cut, fatigue, or diarrhoea.
Decreased platelet production can result in impaired blood clotting, whereby a cut may continue bleed for longer than normal. Also, patients may bruise under the skin from mild injuries. To reduce the risk of uncontrolled bleeding, patients should limit alcohol consumption and stop taking over-the-counter medications such as aspirin and ibuprofen. Severe thrombocytopenia may require a platelet transfusion.
In people with multiple myeloma, excess M protein and calcium in the blood put stress on the kidneys as they filter blood, resulting in impaired function and in severe cases kidney failure.
Most patients with kidney disease do not have any symptoms and are usually unaware they have an issue until the kidneys are severely compromised. A reduction in the amount of urine is one sign.
Staying well hydrated is one way to manage impaired kidney function. The doctor may also advise avoiding alcohol and anti-inflammatory drugs (such as Advil, Motrin, or Aleve). Blood pressure sould be monitored.
Depending on the severity of their kidney impairment, patients may need to undergo plasmapheresis (a procedure where some of the blood is removed, processed, and returned) or dialysis (a procedure where waste products are removed from your blood through use of a special machine).
Multiple myeloma leads to bone loss in two ways. First, multiple myeloma cells form masses in the bone marrow, disrupting the surrounding bone’s normal. Second, myeloma cells boost the activity of other cells that are responsible for breaking down bone. This can cause small holes (called lytic lesions) to develop in bones, which weakens them. The holes are visible on an x-ray.
About 85% of people with multiple myeloma have some type of bone damage (osteolytic lesions) or loss (osteoporosis, also known as brittle bones). The most commonly affected areas are the spine, pelvis, and rib cage.
With weakened bones, people with multiple myeloma often experience bone pain and have an increased risk of fracture or vertebral bone collapse, which may cause spinal cord compression, which requires immediate treatment to avoid long-term damage.
Common ways to manage bone damage in people with multiple myeloma include exercise, supplementation with calcium and vitamin D, use of bisphosphonates and other medications, orthopedic interventions, low-dose radiation therapy.
Bone destruction can increase the level of calcium in the blood, called hypercalcemia, which can be serious if not treated immediately. Severe cases can cause coma or cardiac arrest.
Symptoms include loss of appetite, increased thirst, increased urination, restlessness, confusion or finding it hard to think, nausea and vomiting
Research has greatly improved the prognosis for multiple myeloma patients.
Symptoms, age, classification (subtype of myeloma), and stage of disease are significant factors in terms of prognosis. Prognostic indicators help determine how fast the myeloma is growing, the extent of disease, the biological makeup, the response to therapy, and the overall health status of the patient.
Determining the stage of the disease is one of the most significant factors in developing a personalized treatment plan.
Just as every person is different, every multiple myeloma diagnosis is unique. Survival statistics are therefore purely indicative and cannot predict the outcome for an individual. That said, the 5-year survival rate for myeloma patients diagnosed between 2015 and 2020 was 61.1% in the US (Source: (US) National Cancer Institute Surveillance, Epidemiology, and End Results Program (SEER) database).
Based on an article by the Multiple Myeloma Research Foundation
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