Multiple Myeloma: Causes, Symptoms, Diagnosis, and Treatment

Multiple myeloma is a form of cancer that develops in plasma cells, which are specialized white blood cells that help fight infections. Normally, healthy plasma cells make proteins called antibodies. In the case of a patient having multiple myeloma, the plasma cells are not healthy. They multiply and form unhealthy or abnormal antibodies. As a result, it can lead to several health issues that damage the bones, harm the kidneys, and disrupt the production of blood cells and platelets. Although multiple myeloma has no cure, its symptoms can be controlled, and the disease’s progression can be delayed.

The soft substance inside bones that helps produce blood cells is called bone marrow. When multiple myeloma develops, abnormal plasma cells begin multiplying in the bone marrow. They soon outnumber the healthy blood cells. Instead of making antibodies that are healthy, the cancerous plasma cells make a different kind of protein that doesn’t do what healthy antibodies are supposed to do. This leads to the patient developing complications on account of the multiple myeloma condition.

Symptoms

Symptoms are not always evident at the early onset of multiple myeloma. Only when the disease has progressed do some or many of these symptoms show up:

• Constipation
• Bone pain in the hips, chest, and spine
• Nausea
• A sense of confusion or mental fogginess
• A sense of loss of appetite
• Fatigue and overall weakness
• Infections that cause fever
• Feeling thirsty
• Feeling the urge/requiring to urinate frequently
• More bleeding in situations caused by bruises: This is a sign of unhealthy plasma cells, preventing the production of platelets, which normally help the blood to clot

Causes

Medical science has not been able to determine what causes multiple myeloma. However, researchers are examining and considering a few possible causes:

• Genetic Mutations: It is believed that multiple myeloma patients don’t have all the pieces of a specific chromosome. This has led researchers to study the connection between mutating oncogenes, also known as the cells that promote growth, and the disease.
• Inflammatory Disease or Condition: Heart disease, type 2 diabetes, and rheumatoid arthritis are conditions that are inflammatory in nature. Their connection to multiple myeloma is being studied.
• Obesity: The presence of high-fat content in the body is considered a possible cause of multiple myeloma.
• Environmental Factors: Certain studies have linked multiple myeloma to radiation exposure and contact with chemicals found in fertilizers and pesticides.

The onset of multiple myeloma always begins with one plasma cell in the bone marrow. This plasma cell turns cancerous for some reason. It then multiplies quickly. Soon, the cancerous plasma cells outnumber the healthy plasma cells. Normally, healthy cells are born and die in a set pattern with a fixed tenure. But cancerous cells don’t follow this pattern or schedule. Therefore, over time, there are more cancerous cells than healthy cells in the bone marrow. This means the body is no longer able to fight infections as well as it should be. The patient also begins to experience fatigue. Even as the other symptoms begin to show, the disease begins to damage the patient’s kidneys.

Risk Factors

Certain factors may increase the risk of developing multiple myeloma. These factors do not cause the disease, but they may raise the chance of getting it.

• Age: Multiple myeloma mostly affects older adults. Most people are diagnosed between the ages of 40 and 70, with many cases found in the late 60s.
• Sex: Men have a higher risk of developing multiple myeloma compared to women.
• Race: Black people have a higher risk of developing multiple myeloma compared to people of other races.
• Family history: Having a parent or sibling with multiple myeloma may increase the risk. However, this disease is not considered hereditary.
• MGUS: People with monoclonal gammopathy of undetermined significance (MGUS) have a higher risk. Multiple myeloma often starts as MGUS.
• Environmental exposure: Contact with certain chemicals, such as pesticides, fertilizers, or Agent Orange, may increase risk.
• Obesity: Being overweight or obese is a known risk factor for multiple myeloma.

There is no known way to prevent multiple myeloma. If someone develops this condition, it is not due to anything they did wrong.

Diagnosis and Treatment

Doctors begin diagnosing multiple myeloma with a thorough physical examination and a complete understanding of the patient’s family history.

These are some of the tests that may be ordered:

• Complete Blood Count (CBC): This test measures the number of white and red blood cells in the body, the concentration level of red blood cells, and the amount of hemoglobin in the red blood cells.
• Quantitative Immunoglobulin Test: This is done to measure the level of some antibodies in the blood.
• Blood Chemistry Test: This is required to measure lactic dehydrogenase levels (LDH). LDH is a tumor marker. Additionally, this test tells how the kidneys are working (through creatine levels). It also gives details of albumin (a protein) levels and calcium levels.
• Electrophoresis: This test determines the presence of M proteins in the blood. Monoclonal or M proteins are antibodies that cancerous cells make that cause all the complications associated with multiple myeloma.
• X-ray: To study the impact of the disease on the bones.
• CT Scan: To study bone damage in greater detail.
• MRI: This imaging test is required to look for plasmacytomas, single groups of abnormal plasma cells.
• PET Scan: This is another test that can help identify plasmacytomas.
• Bone Marrow Biopsy: Doctors may order multiple biopsies to assess and compare the proportion of normal and abnormal plasma cells in the body. This test will also be useful to test the DNA of the patient to assess the potential for the cancer to grow in the future.

Multiple myeloma cannot be cured. However, a combination of treatment options will be attempted by the doctor once multiple myeloma has been diagnosed. This is mainly to manage the symptoms and slow down the progression of the disease. These options include:

• Medication to manage pain.
• Antibiotics are used to fight and kill infections.
• Chemotherapy is used to bring down the number of abnormal plasma cells.
• Steroids are used to fight inflammation and kill the cancerous cells.
• Radiation therapy reduces bone tumors and kills cancerous cells.
• Immunotherapy helps the immune system fight the disease by producing more cancer-fighting cells.
• Stem cell transplants replace unhealthy stem cells with healthy stem cells from the patient’s body. In rare cases, a donor’s healthy plasma stem cells may be used.

Complications

Multiple myeloma can lead to several serious health problems. These complications may affect different parts of the body and require careful medical management.

• Bone problems: Multiple myeloma weakens bones, causing pain, thinning, and fractures. Spine bones may also press on the spinal cord, leading to nerve issues.
• Blood problems: The disease can lower red blood cells, causing anemia. This makes you feel tired, pale, or short of breath. It can also reduce platelets, which makes blood clotting harder.
• Infections: Myeloma affects the immune system by crowding out healthy antibodies, making it harder for your body to fight infections like pneumonia.
• Kidney damage: Abnormal proteins from myeloma can harm the kidneys, sometimes leading to kidney failure.
• High calcium levels: Bone breakdown can release too much calcium into the blood (hypercalcemia), causing nausea, confusion, or weakness.
• Nerve damage: Some patients experience peripheral neuropathy, which causes tingling, numbness, or pain in hands and feet.
• Other serious complications: Conditions like hyperviscosity syndrome (thick blood) or amyloidosis (organ damage from abnormal proteins) may occur and need urgent care.

Healthcare providers work to manage and prevent these complications, helping patients stay as healthy and comfortable as possible.

Living with Multiple Myeloma

As it is with all cancers, early detection is important in the case of multiple myeloma, too. Patients are known to have lived for 10 years or more with multiple myeloma.

Patients can consider taking the following steps to cope with the condition and live with it:

• Eat healthy foods. Eat smaller meals, frequently. This is because multiple myeloma results in loss of appetite. This is a way to work around that situation.
• Rest well.
• Quit smoking if you have the habit.
• Prevent infections as much as possible.
• Collaborate with your doctor and work on starting a simple exercise routine.
• Preserve yourself emotionally. Talk to family, friends, and a therapist, if required.

Multiple myeloma is a blood cancer. It affects the plasma cells. It is rare and cannot be cured. Early detection always helps. The doctor will start a treatment plan that works on managing the symptoms and slowing the progression of the disease. People have lived for years with the condition. Others have the condition in remission. But it is never easy living with cancer. So understanding the condition, developing an outlook to manage it, and slowing down its progress is important.

Frequently Asked Questions