Source: Cancer Resource Room

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.

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.

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 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 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, 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
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.

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.

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