Multiple myeloma is a type of cancer caused by malignant plasma cells in your bone marrow. Plasma cells produce antibodies that help your body fight infections. If you have multiple myeloma your plasma cells produce unhealthy antibodies called monoclonal proteins (M proteins). The accumulation of M proteins in your body can damage organs like your kidneys and liver.
The risk of developing multiple myeloma increases with age. Risk is also higher for:
- people with a history of monoclonal gammopathy of undetermined significance (MGUS)
If you have MGUS, M proteins are in your blood, but you don’t have the disease.
Multiple myeloma can cause different symptoms including:
- bone pain
- loss of appetite
- weight loss
- excessive thirst
The earlier you're diagnosed, the sooner you can begin treatment to manage your symptoms. It's helpful to keep a record of the symptoms you’re experiencing. The more information you can give your doctor, the better. Your doctor may suspect multiple myeloma after hearing about your symptoms.
You may not have symptoms if you're in an early stage of the disease. After a routine physical examination, an abnormal blood test could prompt your doctor to investigate further. Your primary doctor may refer you to doctor specializing in blood disorders (hematologist) or a doctor who treats cancer (oncologist) for more testing.
Your doctor can use a few test to make an accurate diagnosis. Here's what you can expect:
To diagnose or rule out multiple myeloma, your doctor may order blood tests to check for M proteins produced by plasma cells. This protein will be in your blood if you have the disease. Blood testing may also find beta-2 microglobulin, which is another abnormal protein.
Your doctor can also order blood tests to check your:
- erythrocyte sedimentation rate (ESR)
- plasma viscosity
- blood cell count
- blood calcium level
- kidney function
Your doctor may use a urine sample to diagnose the disease. A urine analysis can detect M proteins in your urine. Since this protein can damage your kidneys, a urine sample also helps your doctor check how well your kidneys are functioning.
Bone marrow aspiration and biopsy
Since plasma cells are found in your bone marrow, your doctor may order a bone marrow biopsy and aspiration. During this procedure, you’ll be given local anesthesia. Your doctor will then insert a needle into a bone and remove a sample of bone marrow.
Biopsy and aspiration is routine when diagnosing conditions involving the bone marrow or blood cells. The results of your test will also reveal the progression of the disease.
Your doctor may order imaging tests to look inside your body. Imaging tests can show problems with your bones, like holes that develop due to a tumor. Imaging tests can include the following:
Your doctor will diagnose multiple myeloma after reviewing the results of your lab tests, imaging tests, and bone marrow biopsy. If you have the disease, the next step is determining the extent of the disease. Based on your results, your doctor may classify your disease as stage 1, stage 2, or stage 3.
A stage 1 diagnosis is an early stage of the disease. This means your outlook is more favorable than a stage 3 diagnosis. A stage 3 diagnosis indicates an aggressive form of the disease that may have already started to affect your bones and organs.
There are two systems used to stage multiple myeloma. One system is the International Staging System (ISS), which determines the stage based on your health and the amount of beta-2 microglobulin in your bloodstream.
The Durie-Salmon Staging System can also be used. This system determines the stage based on bone damage, M protein production, and the level of hemoglobin and calcium in your blood.
Knowing your stage helps your doctor decide on the best treatment. If you’re stage 1 or diagnosed with MGUS, treatment might not be necessary at this time. You’ll still need to be monitored. This involves having periodic blood testing and urine analysis.
If you’re stage 2 or stage 3, treatment can include the following:
- corticosteroids to strengthen your immune system and reduce inflammation
- targeted drug treatment to destroy myeloma cells
- stem cell transplant to replace unhealthy marrow with healthy marrow
- radiation therapy to stop the growth of cancerous cells
Asking your doctor the right questions is an important first step after being diagnosed with multiple myeloma. Getting enough information will help guide your next steps. This will mean moving forward with the best treatment plan.
Examples of questions to ask your doctor include:
- What is your experience treating people with multiple myeloma?
- What is your plan for treatment? How do you help determine the treatment course based on one’s preferences?
- What kinds of clinical trials are available for people diagnosed with stage 3?
- What kinds of local support groups are available for me?
- Will you be my main point of contact during treatment?
- Will I need to see any other kinds of specialists, like nutritionists or physical therapists?
There’s no cure for multiple myeloma but with an early diagnosis and treatment, recovery is possible. After your diagnosis it's also important to have a strong support system.
Talk with your doctor and learn as much about this disease as possible. Ask for information on joining a support group so you can connect with other people with the condition. You could also consider one-on-one therapy to learn coping strategies.
Keep yourself busy with enjoyable activities and staying active. Doing things like walking, gardening, biking, or swimming can also help you maintain a positive outlook. Exercise can boost your immune system and improve your mental health. But while you’ll want to be active, don’t overdo it. Relax when you're tired and recognize your limitations.