Also known as Kahler’s Disease, Multiple Myeloma is a type of cancer that forms in the plasma cells. Plasma cells are a type of white blood cell that make antibodies crucial in identifying and fighting infections in the body.
Overview
What happens in Multiple Myeloma?
Abnormal plasma cells multiply very quickly and accumulate in the bone marrow. Over time, healthy blood cells will be crowded out and the cancerous plasma cells could result in bones being eaten away, causing lytic lesions. As the number of the cancerous plasma cells increases, the production of healthy red blood cells, white blood cells and platelets drops.
These cancerous plasma cells can also secrete cancer proteins, also referred to as monoclonal protein (M-protein), or paraprotein, which can gradually accumulate throughout the body and cause organ damage, for which the kidneys are most susceptible.
The term “multiple” refers to numerous tumours that develops in different locations.
Other types of plasma cell disorders
As the name suggests, solitary plasmacytomas is when there is only one tumour that typically develops either inside a bone or on the outside. Solitary plasmacytomas are usually treated with radiation therapy.
Monoclonal Gammopathy of Undetermined Significance (MGUS)
This condition is typically discovered through a blood test and will present in the form of an unusually high level of protein in the blood. MGUS is not cancer and will not cause the same complications as Multiple Myeloma (high calcium levels, low blood count, kidney and bone problems).
Despite the fact that plasma cells in MGUS do not develop into a tumour or mass, it is still a cause for concern when diagnosed as it is considered pre-malignant; 1% of people with MGUS will eventually develop multiple Myeloma.
Amyloidosis occurs when an abnormal protein, called amyloid, builds up in the organs and interferes with their normal function. Organs that may be affected include the heart, kidneys, liver, spleen, nervous system and digestive tract. Amyloidosis frequently results from a clone of abnormal plasma cells in the bone marrow
Waldenstrom Macroglobulinemia (WM)
The cancer cells found in WM contain features of Multiple Myeloma and non-Hodgkin’s Lymphoma. Cancer cells of Waldenstrom Macroglobulinemia also produce M proteins, which will cause many symptoms including vision impairment, numbness, shortness of breath and confusion. Treatment for WM includes drugs used in Multiple Myeloma and non-Hodgkin’s Lymphoma therapy.
Causes
It is still unknown what causes Multiple Myeloma, but doctors know that myeloma starts with mutations of healthy plasma cell in the bone marrow and these mutated plasma cells grow and multiply, resulting in the deleterious effects of multiple myeloma.
Risk Factors
Some of the risk factors for Multiple Myeloma are:
Gender – Men are more susceptible to Multiple Myeloma than women.
Age – the risk of developing Multiple Myeloma increases with age and is typically diagnosed in people aged 55 and above.
Family history – those with a family history of Multiple Myeloma.
Personal medical history – those with a medical history of Monoclonal Gammopathy of Undetermined Significance (MGUS).
Signs and Symptoms
Patients typically do not notice any symptoms in the earlier stages of Multiple Myeloma. When they do become noticeable later on, they may include:
- Reduced urine
- Pain in the bones, in the spine or ribs
- Confusion
- Sudden and unexpected weight loss and/or decreased appetite
- Fatigue and weakness
- Infections
- Numbness in extremities
Complications
Bone problems
In Multiple Myeloma, the cells that are responsible for maintaining bone strength are affected. The 2 bone cells that work together to keep the bones strong are Osteoclasts, which break down old bones, and Osteoblasts, which build new bones.
The abnormal cells in Multiple Myeloma produce a chemical that signals the Osteoclasts to break down old bone at a faster rate. As Osteoblasts are unable to keep up with the breaking down of the old bones by producing new ones, the bones in the body become brittle and weak. As a result, Multiple Myeloma patients often suffer from fractured bones and increased calcium levels.
Low Blood Count
As damaged and cancerous plasma cells crowd out healthy red blood cells, white blood cells and platelets, patients usually present with low blood counts. This results in
- Anemia, a shortage of red blood cells, which causes the patient to become fatigued.
- Thrombocytopenia, low platelet level, leads to an increase in unusual bruising and bleeding.
- Leukopenia, low white blood cell level, means the body is unable to effectively battle infections.
Infections
Regular plasma cells provide the body with a strong defence system against infections. However, in Multiple Myeloma, the plasma cells are unhealthy and damaged, and are unable to do much in fighting infections. Additionally, the white blood cells that are needed to protect the body are either absent or insufficient.
Kidney Problems
The cancer cells in Multiple Myeloma may produce an antibody that damages the kidneys and this which may eventually lead to kidney failure.
Diagnosis
Blood tests
Blood tests will reveal if there are any M proteins, usually produced by cancerous plasma cells, and a type of unhealthy protein, beta-2-microglobulin, in the blood. These will provide the doctor with an idea of how aggressive the cancer is.
The blood tests will also test for the level of the red blood cells, white blood cells and platelets in the body, as well as for calcium levels, uric acid levels and other antibodies.
Urine test
An analysis of a sample of urine will reveal if there are M proteins, also referred to as Bence Jones proteins. A high level of Bence Jones protein is detrimental to the kidneys as they can obstruct the normal functions of the kidneys and cause damage.
Bone marrow biopsy
A sample will be taken from the bone marrow and sent to the laboratory to test for cancer cells. Further testing, such as fluorescence in situ hybridization (FISH) and cytogenetics can detect genetic mutations and help prognosticate the disease and inform the most appropriate treatment.
Radiological tests
Radiological tests may be recommended to image the bones and detect bone problems associated with multiple myeloma. These tests may include an X-ray, MRI, CT or positron emission tomography (PET) scan.
You can find out more about treatment options for myeloma or contact us for an appointment.