Source: Cancer Resource Room
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.
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
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 deals mainly with multiple
(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 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:
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.
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,
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
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; 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.
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
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.
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