Keeping on Top of Your Condition
What Is Multiple Myeloma?
Multiple myeloma is a type of cancer.
It affects certain white
blood cells called plasma
cells. To understand multiple myeloma, it is helpful to know about
normal cells, especially plasma cells, and what happens when they become
cancerous.
Normal Cells
The body is made up of many kinds of cells. Each type of cell has
special functions. Normal cells are produced in an orderly, controlled way
as the body needs them. This process keeps us healthy.
Plasma cells and other white blood cells are part of the immune
system, which helps protect the body from infection and disease.
All white blood cells begin their development in the bone
marrow, the soft, spongy tissue
that fills the center of most bones. Certain white blood cells leave the
bone marrow and mature in other parts of the body. Some of these develop
into plasma cells when the immune system needs them to fight substances
that cause infection and disease.
Plasma cells produce antibodies,
proteins that move through the bloodstream to help the body get rid of
harmful substances. Each type of plasma cell responds to only one specific
substance by making a large amount of one kind of antibody. These
antibodies find and act against that one substance. Because the body has
many types of plasma cells, it can respond to many substances.
Cancer
Cancer is a group of diseases with one thing in common: Cells become
abnormal and are produced in large amounts. Cancerous cells interfere with
the growth and functions of normal cells. In addition, they can spread
from one part of the body to another.
Myeloma Cells
When cancer involves plasma cells, the body keeps producing more and
more of these cells. The unneeded plasma cells -- all abnormal and all
exactly alike -- are called myeloma cells.
Myeloma cells tend to collect in the bone marrow and in the hard, outer
part of bones. Sometimes they collect in only one bone and form a single
mass, or tumor,
called a plasmacytoma.
In most cases, however, the myeloma cells collect in many bones, often
forming many tumors and causing other problems. When this happens, the
disease is called multiple myeloma. This booklet deals mainly with
multiple myeloma.
(It is important to keep in mind that cancer is classified by the type
of cell or the part of the body in which the disease begins. Although
plasmacytoma and multiple myeloma affect the bones, they
begin in cells of the immune system. These cancers are different
from bone cancer, which actually begins in cells that form the
hard, outer part of the bone. This fact is important because the diagnosis
and treatment of plasmacytoma and multiple myeloma cancer are different from the
diagnosis and treatment of bone cancer.)
Because people with multiple myeloma have an abnormally large number of
identical plasma cells, they also have too much of one type of antibody.
These myeloma cells and antibodies can cause a number of serious medical
problems:
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As myeloma cells increase in number, they damage and weaken bones,
causing pain and sometimes fractures. Bone pain can make it difficult
for patients to move.
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When bones are damaged, calcium
is released into the blood. This may lead to hypercalcemia
-- too much calcium in the blood. Hypercalcemia can cause loss of
appetite, nausea, thirst, fatigue, muscle weakness, restlessness, and
confusion.
-
Myeloma cells prevent the bone marrow from forming normal plasma
cells and other white blood cells that are important to the immune
system. Patients may not be able to fight infection and disease.
-
The cancer cells also may prevent the growth of new red blood cells,
causing anemia.
Patients with anemia may feel unusually tired or weak.
-
Multiple myeloma patients may have serious problems with their kidneys.
Excess antibody proteins and calcium can prevent the kidneys from
filtering and cleaning the blood properly.
Symptoms of Multiple Myeloma Cancer
Symptoms of multiple myeloma depend on how advanced the disease is. In
the earliest stage of the disease, there may be no symptoms. When symptoms
do occur, patients commonly have bone pain, often in the back or ribs.
Patients also may have broken bones, weakness, fatigue, weight loss, or
repeated infections. When the disease is advanced, symptoms may include
nausea, vomiting, constipation, problems with urination, and weakness or
numbness in the legs. These are not sure signs of multiple myeloma cancer; they
can be symptoms of other types of medical problems. A person should see a
doctor if these symptoms occur. Only a doctor can determine what is
causing a patient's symptoms.
Diagnosis
Multiple myeloma may be found as part of a routine physical exam before
patients have symptoms of the disease. When patients do have symptoms, the
doctor asks about their personal and family medical history and does a
complete physical exam. In addition to checking general signs of health,
the doctor may order a number of tests to determine the cause of the
symptoms. If a patient has bone pain, x-rays
can show whether any bones are damaged or broken. Samples of the patient's
blood and urine are checked to see whether they contain high levels of
antibody proteins called M
proteins. The doctor also may do a bone
marrow aspiration and/or a bone
marrow biopsy to check for myeloma cells. In an aspiration, the
doctor inserts a needle into the hip bone or breast bone to withdraw a
sample of fluid and cells from the bone marrow. To do a biopsy, the doctor
uses a larger needle to remove a sample of solid tissue from the marrow. A
pathologist
examines the samples under a microscope to see whether myeloma cells are
present.
To plan a patient's treatment, the doctor needs to know the stage, or
extent, of the disease. Staging
is a careful attempt to find out what parts of the body are affected by
the cancer. Treatment decisions depend on these findings. Results of the
patient's exam, blood tests, and bone marrow tests can help doctors
determine the stage of the disease. In addition, staging usually involves
a series of x-rays to determine the number and size of tumors in the
bones. In some cases, a patient will have MRI
if closeup views of the bones are needed.
Multiple Myeloma Treatment
Treatment depends on the extent of the cancer and the patient's
symptoms. The doctor also considers the person's age and general health.
The doctor may want to discuss the patient's case with other doctors who
treat multiple myeloma cancer. Also, the patient may want to talk with the doctor
about taking part in a research study of new treatment methods. Such
studies, called clinical
trials, are designed to improve the treatment of this type of
cancer. These studies are discussed in the Treatment
Studies section.
Many patients want to learn all they can about their disease and their
treatment choices so they can take an active part in decisions about their
medical care. Patients have many important questions about their health,
and the doctor is the best person to answer them. Most people want to know
the extent of their cancer, how it can be treated, how effective the
treatment is likely to be, and how much it is expected to cost. These are
some questions patients may want to ask the doctor:
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What are my treatment choices?
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Would a clinical trial be appropriate for me?
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What are the expected benefits of treatment?
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What are the risks and possible side effects of treatment?
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If I have pain, how will you help me?
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Will I need to change my normal activities?
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How often will I need to have checkups?
Many people find it helpful to make a list of their questions before
they see the doctor. Taking notes can make it easier to remember what the
doctor says. Some patients also find that it helps to have a family member
or friend with them when they see the doctor -- to take part in the
discussion or just to listen.
There is a lot to learn about cancer and its treatment. Patients do not
need to ask all their questions or remember all the answers at one time.
They will have other chances to ask the doctor to explain things and to
get more information.
Before Treatment
Treatment decisions for multiple myeloma are complex. Before starting
treatment, the patient might want a second doctor to review the diagnosis
and treatment plan. A short delay usually does not reduce the chance that
treatment will be effective. There are a number of ways to find a doctor
for a second opinion:
-
The patient's doctor may be able to suggest a doctor who treats
multiple myeloma. Doctors who specialize in treating this disease
include oncologists,
hematologists,
and radiation
oncologists.
-
The Cancer Information Service, at 1-800-4-CANCER, can tell callers
about treatment facilities, including cancer centers and other
NCI-supported programs in their area.
-
Patients can get the names of doctors from their local medical
society, a nearby hospital, or a medical school.
Multiple Myeloma Treatment Methods
Plasmacytoma and multiple myeloma are very hard to cure. Although
patients who have a plasmacytoma may be free of symptoms for a long time
after treatment, many eventually develop multiple myeloma. For those who
have multiple myeloma, treatment can improve the quality of a patient's
life by controlling the symptoms and complications of the disease.
People who have multiple myeloma but do not have symptoms of the
disease usually do not receive treatment. For these patients, the risks
and side effects of treatment are likely to outweigh the possible
benefits. However, these patients are watched closely, and they begin
treatment when symptoms appear. Patients who need treatment for multiple
myeloma usually receive chemotherapy
and sometimes radiation
therapy.
Chemotherapy is the use of drugs to treat cancer. It is the main
treatment for multiple myeloma. Doctors may prescribe two or more drugs
that work together to kill myeloma cells. Many of these drugs are taken by
mouth; others are injected into a blood vessel. Either way, the drugs
travel through the bloodstream, reaching myeloma cells all over the body.
For this reason, chemotherapy is called systemic
therapy.
Anticancer drugs often are given in cycles -- a treatment period
followed by a rest period, then another treatment and rest period, and so
on. Most patients take their chemotherapy at home, as outpatients at the
hospital, or at the doctor's office. However, depending on their health
and the drugs being given, patients may need to stay in the hospital
during treatment.
Radiation therapy (also called radiotherapy) uses high-energy rays to
damage cancer cells and stop them from growing. In this form of treatment,
a large machine aims the rays at a tumor and the area close to it.
Treatment with radiation is local
therapy; it affects only the cells in the treated area.
Radiation therapy is the main treatment for people who have a single
plasmacytoma. They usually receive radiation therapy every weekday for 4
to 5 weeks in the outpatient department of a hospital or clinic.
People who have multiple myeloma sometimes receive radiation therapy in
addition to chemotherapy. The purpose of the radiation therapy is to help
control the growth of tumors in the bones and relieve the pain that these
tumors cause. Treatment usually lasts for 1 to 2 weeks.
Treatment Studies Relevant to Multiple Myeloma
Because multiple myeloma is so hard to control, many researchers are
looking for more effective treatments. They also are looking for
treatments that have fewer side effects and for better ways to care for
patients who have complications caused by this disease. When laboratory
research shows that a new method has promise, doctors use it to treat
cancer patients in clinical trials. These trials are designed to find
out whether the new approach is both safe and effective and to answer
scientific questions. Patients who take part in clinical trials may have
the first chance to benefit from improved treatment methods, and they make
an important contribution to medical science.
Many clinical trials of new treatments for multiple myeloma are under
way. In some studies, doctors are testing new drugs and new drug
combinations. In others, they are using chemotherapy along with biological
therapy, treatment with substances that boost the immune system's
response to cancer.
Researchers also are testing new approaches to cancer treatment that
allow the use of very high doses of anticancer drugs, sometimes along with
radiation. Doctors believe that higher doses of anticancer drugs and
radiation might be more effective than the usual doses in destroying
myeloma cells. However, higher doses also cause greater damage to healthy
bone marrow. New approaches to treatment may help the healthy marrow
recover or may allow doctors to replace marrow that is destroyed.
Patients interested in taking part in a clinical trial should discuss
this option with their doctor.
One way to learn about clinical trials is through
PDQ, a computerized resource developed
by the National Cancer Institute. This resource contains information about
cancer treatment and about clinical trials in progress all over the
country. The Cancer Information Service can provide PDQ information to
patients and the public.
Side Effects of Treatment
The methods used to treat multiple myeloma are very powerful. Treatment
can help patients feel better by relieving symptoms such as bone pain.
However, it is hard to limit the effects of therapy so that only cancer
cells are destroyed. Because healthy cells also may be damaged, treatment
can cause unpleasant side effects.
The side effects that patients have during cancer treatment vary for
each person. They may even be different from one treatment to the next.
Doctors try to plan treatment to keep side effects to a minimum. They also
monitor patients very carefully so they can help with any problems that
occur.
The side effects of chemotherapy depend on the drugs that are given. In
general, anticancer drugs affect rapidly growing cells, such as blood
cells that fight infection, cells that line the digestive tract, and cells
in hair
follicles. As a result, patients may have lower resistance to
infection, loss of appetite, nausea, vomiting, or mouth sores. Patients
also may have less energy and may lose their hair. One drug used to treat
multiple myeloma, called prednisone,
may cause swelling of the face and feet, burning indigestion, mood swings,
restlessness, and acne. The side effects of chemotherapy usually go away
over time after treatment stops.
During radiation therapy, the patient may be more tired than usual.
Resting is important, but doctors usually advise patients to stay as
active as they can. Also, the skin in the treated area may become red or
dry. The skin should be exposed to the air but protected from the sun, and
patients should avoid wearing clothes that rub the treated area. They
should not use any lotion or cream on the skin without the doctor's
advice. Patients may have other side effects, depending upon the areas
treated. For example, radiation to the lower back may cause nausea,
vomiting, or diarrhea because the lower digestive tract is exposed to
radiation. The doctor often can prescribe medicine or suggest changes in
diet to ease these problems. Side effects usually disappear gradually
after radiation therapy is over.
Loss of appetite can be a problem for patients with multiple myeloma.
People may not feel hungry when they are uncomfortable or tired. Some of
the common side effects of cancer treatment, such as nausea and vomiting,
can also make it hard to eat. Yet patients who eat well often feel better
and have more energy, so good nutrition is important. Eating well means
getting enough calories and protein to prevent weight loss, regain
strength, and rebuild normal tissues. Many patients find that having
several small meals and snacks during the day works better than having
three regular meals.
Doctors, nurses, and dietitians can explain the side effects of cancer
treatment and can suggest ways to deal with them.
Supportive Care
The complications of multiple myeloma can affect many parts of the
body. Chemotherapy and radiation therapy often can help control
complications such as pain, bone damage, and kidney problems. However,
from time to time, most patients need additional treatment to manage these
and other problems caused by the disease. This type of treatment, called
supportive care, is given to improve patients' comfort and quality of
life.
Patients with multiple myeloma frequently have pain caused by bone
damage or by tumors pressing on nerves. Doctors often suggest that
patients take pain medicine and/or wear a back or neck brace to help
relieve their pain. Some patients find that techniques such as relaxation
and imagery can reduce their pain.
Preventing or treating bone fractures is another important part of
supportive care. Because exercise can reduce the loss of calcium from the
bones, doctors and nurses encourage patients to be active, if possible.
They may suggest appropriate forms of exercise. If a patient has a
fracture or a breakdown of certain bones, especially those in the spine, a
surgeon may need to operate to remove as much of the cancer as possible
and to strengthen the bone.
Patients who have hypercalcemia may be given medicine to reduce the
level of calcium in the blood. They also are encouraged to drink large
amounts of fluids every day; some may need intravenous
(IV)
fluids. Getting plenty of fluids helps the kidneys get rid of excess
calcium in the blood. It also helps prevent problems that occur when
calcium collects in the kidneys.
If the kidneys aren't working well, dialysis
or plasmapheresis
may be necessary. In dialysis, the patient's blood passes through a
machine that removes wastes, and the blood is then returned to the
patient. Plasmapheresis is used to remove excess antibodies produced by
the myeloma cells. This process thins the blood, making it easier for the
kidneys and the heart to function.
Multiple myeloma weakens the immune system. Patients must be very
careful to protect themselves from infection. It is important that they
stay out of crowds and away from people with colds or other infectious
diseases. Any sign of infection (fever, sore throat, cough) should be
reported to the doctor right away. Patients who develop infections are
treated with antibiotics
or other drugs.
Patients who have anemia may have transfusions of red blood cells.
Transfusions can help reduce the shortness of breath and fatigue that can
be caused by anemia.
Followup Care
Regular followup is very important for anyone who has multiple myeloma.
Checkups generally include a physical exam, x-rays, and blood and urine
tests. Regular followup exams help doctors detect and treat problems
promptly if they should arise. It is also important for the patient to
tell the doctor about any new symptoms or problems that develop between
checkups.
Living With Multiple Myeloma Cancer
The diagnosis of multiple myeloma can change the lives of patients and
the people who care about them. These changes can be hard to handle. It is
common for patients and their families and friends to have many different
and sometimes confusing emotions.
At times, patients and their loved ones may feel frightened, angry, or
depressed. These are normal reactions when people face a serious health
problem. Most people handle their problems better if they can share their
thoughts and feelings with those close to them. Sharing can help everyone
feel more at ease and can open the way for people to show one another
their concern and offer their support.
Worries about tests, treatments, hospital stays, and medical bills are
common. Doctors, nurses, social workers, and other members of the health
care team may help calm fears and ease confusion. They also can provide
information and suggest resources.
Patients and their families are naturally concerned about what the
future holds. Sometimes people use statistics to try to figure out whether
a cure is possible or how long the patient will live. It is important to
remember, however, that statistics are averages based on large numbers of
patients. They can't be used to predict what will happen to a certain
patient because no two cancer patients are alike. The doctor who takes
care of the patient and knows his or her history is in the best position
to discuss the person's outlook (prognosis).
People should feel free to ask the doctor about their prognosis, but
not even the doctor knows for sure what will happen. Doctors may talk
about the chances of remission.
They also may talk about managing or controlling multiple myeloma cancer rather
than curing it, even when patients respond well to treatment. They use
these terms because the disease may get worse at a later time.
Services for Cancer Patients
Living with a serious disease isn't easy. Cancer patients and those who
care about them face many problems and challenges. Finding the strength to
cope with these difficulties is easier when people have helpful
information and support services.
The doctor can explain the disease and give advice about treatment,
working, or other activities. Patients also may want to discuss concerns
about the future, family relationships, and finances. It may help to talk
with a nurse, social worker, counselor, or member of the clergy.
Friends and relatives can be very supportive. Also, it helps many
patients to meet and talk with others who are facing problems like theirs.
Cancer patients often get together in support groups, where they can share
what they have learned about cancer, its treatment, and coping with the
disease. It's important to keep in mind, however, that each patient is
different. Treatments and ways of dealing with cancer that work for one
person may not be right for another -- even if they both have the same
kind of cancer. It is always a good idea to discuss the advice of friends
and family members with the doctor.
Often, a social worker at the hospital or clinic can suggest local and
national groups that help with rehabilitation, emotional support,
financial aid, transportation, or home care.
Possible Multiple Myeloma Causes
Scientists at hospitals, medical schools, and research laboratories
across the country are studying multiple myeloma cancer. At this time, we do not
know what causes this disease or how to prevent it. However, we do know
that no one can "catch" multiple myeloma from another person; cancer is
not contagious.
Although scientists cannot explain why one person gets multiple myeloma
and another doesn't, we do know that most multiple myeloma patients are
between 50 and 70 years old. This disease affects blacks more often than
whites and men more often than women.
Some research suggests that certain risk
factors increase a person's chance of getting multiple myeloma cancer.
For example, a person's family background appears to affect the risk of
developing multiple myeloma; children and brothers and sisters of patients
who have this disease have a slightly increased risk. Farmers and
petroleum workers exposed to certain chemicals also seem to have a
higher-than-average chance of getting multiple myeloma. In addition,
people exposed to large amounts of radiation (such as survivors of the
atomic bomb explosions in Japan) have an increased risk for this disease.
Scientists have some concern that smaller amounts of radiation (such as
those radiologists and workers in nuclear plants are exposed to) also may
increase the risk. At this time, however, scientists do not have clear
evidence that large numbers of medical x-rays increase the risk for
multiple myeloma cancer. In fact, most people receive a fairly small number of
x-rays, and scientists believe that the benefits of medical x-rays far
outweigh the possible risk for multiple myeloma.
In most cases, people who develop multiple myeloma have no clear risk
factors. The disease may be the result of several factors (known and/or
unknown) acting together.
Keeping on Top of Your Condition
Keeping in tune with your disease or condition not only makes treatment less intimidating but also increases its chance of success, and has been shown to lower a patients risk of complications. As well, as an informed patient, you are better able to discuss your condition and treatment options with your physician.
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