But multiple myeloma often has no outward signs in its early stages, making it difficult to identify. In fact, 1 in 5 myeloma patients are diagnosed with the disease only because they’ve gone to the doctor for routine medical exams and had lab tests that revealed telltale changes in blood or urine. (1) Multiple myeloma can be easy to overlook even when there are symptoms, because common signs, such as fatigue, can be attributed to other health conditions or even simply to aging. (2) RELATED: Obesity Triggering Rising Cancer Rates in Millenials
Signs and Symptoms That Occur With Multiple Myeloma
As cancerous plasma cells multiply within the bone marrow, they reveal their presence in a number of ways. The main three tend to be: Bone Pain and Fractures Bone pain, typically in the spine or ribs but possibly in any bone, is often one of the earliest signs of multiple myeloma. Myeloma cells stimulate cells that break down bone and inhibit cells that build new bone. This can cause holes in bones, called lytic lesions, and osteoporosis (bone thinning). The result can be constant bone pain that gets worse when you move. Fragile bone can sometimes fracture even from everyday activities, like lifting, sneezing, walking, or coughing. Fatigue and Weakness This is a common problem for people with multiple myeloma. As the cancer becomes more advanced, abnormal plasma cells (also known as myeloma cells) begin to crowd out other cells in bone marrow, including red blood cells. Low red blood cell count or low hemoglobin concentration — what’s known as anemia — can leave you looking pale and make you tire out easily or feel weak. Frequent Infections Myeloma cells compromise the immune system by crowding out healthy white blood cells that produce infection-fighting antibodies. (Myeloma cells make nonfunctional antibodies.) For many people, the first symptom of multiple myeloma might be a urinary, bronchial, lung, skin, or other type of infection. Recurrent infections can also make multiple myeloma harder to treat as it progresses. Multiple myeloma can express itself in an even broader range of symptoms. These may include: Numbness, Tingling, Burning, or Pain in the Hands and Feet Myeloma cells produce an abnormal antibody called M protein (also known as monoclonal immunoglobulin, among other names) that can be toxic to nerves. This can cause a condition called peripheral neuropathy. Increased Thirst and Urination, Constipation, Confusion, and Kidney Damage Due to High Blood Calcium Levels When myeloma cells lead to the breakdown of bone, calcium levels in the blood increase, potentially causing a number of problems. (3) Abnormal Bleeding, Headaches, Chest Pain, Decreased Alertness, or Shortness of Breath These symptoms occur in rare cases of a condition called hyperviscosity syndrome, which occurs when high levels of M protein cause blood to thicken. RELATED: Antibiotics Tied to a 50 Percent Greater Risk of Colon Cancer
C Calcium elevation (high levels of calcium in the blood)R Renal insufficiency (poor kidney function that may be due to a reduction in blood flow)A Anemia (low red blood cell count)B Bone abnormalities (lesions)
More recently, doctors have added a number of other criteria that may separate asymptomatic multiple myeloma from the active kind. These criteria include:
There are at least 60 percent plasma cells in the bone marrow.The free light-chain ratio (involved light-chain to uninvolved light-chain) is 100 or more. Antibodies are composed of “heavy” and “light” protein chains; free light chains are those that don’t bind to heavy chains and are released into the blood. The amount of free light chains corresponds to the amount of plasma in the blood, which could indicate trouble with the plasma cells, according to the University of Rochester. (4) Doctors analyze these chains in order to compare normal antibodies with the abnormal ones produced by myeloma cells.There is more than one focal bone lesion (at least 5 millimeters in size) on magnetic resonance imaging (MRI).
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The Watch-and-Wait Approach to Symptom-Free Multiple Myeloma
When multiple myeloma has no symptoms, it’s called smoldering multiple myeloma (SMM). Despite outward appearances, people with SMM still experience some of the physical changes associated with multiple myeloma. These may include:
A large number of plasma cells in bone marrowA high level of M protein in bloodA high level of light chains in urine (5)
For the first five years after diagnosis, about 10 percent of SMM patients will develop myeloma annually. After that the risk drops to 3 percent until 10 years after diagnosis. (6) Based on these relatively low numbers, physicians generally don’t treat SMM, preferring to watch and wait. The standard approach is to monitor the disease progression through regular blood and urine tests, moving to treatment only when the cancer becomes more advanced. That is typically the case even with SMM patients who seem more likely than others to develop active multiple myeloma, based on laboratory assessments and MRI scans. To question the status quo, the Multiple Myeloma Research Foundation is funding clinical trials to determine whether high-risk SMM patients do better with earlier treatment, and what type of treatment is optimal. (6) RELATED: U.S. Preventive Services Task Force Lowers Colorectal Cancer Screening Age to 45
Finding Relief From Multiple Myeloma Symptoms
In addition to treatments that aim to send multiple myeloma into remission by killing cancer cells, so-called supportive therapies strive to reduce symptoms that make the cancer harder to treat, harm overall health, and cause pain, discomfort, and distress. Therapies include: Antibody Infusions Patients struggling with repeated infections because of lowered antibody counts may receive regular IV (intravenous) infusions of antibodies from donors. These antibodies are called IVIG, or intravenous immunoglobulin. Blood Transfusions Myeloma cells can lower red blood cell counts, and the anemia that may result can leave patients feeling tired and weak. Regular blood transfusions, often given on an outpatient basis, can offer some relief. Plasmapheresis When there are very high levels of M protein, which can thicken blood, patients can develop a variety of problems from altered blood flow through the blood vessels. Plasmapheresis can temporarily remedy this. The patient’s blood flows through a large catheter placed in a vein, into a machine that separates blood cells from blood plasma. The blood plasma, filled with M proteins, is discarded and replaced with donor plasma or salt water. (7)
