Myeloma is a type of blood cancer that develops in the bone marrow from plasma cells. In decreasing order, bone cancers, soft tissue cancers, neuroblastoma and retinoblastoma occur. Rarer cancers include renal, liver, thyroid, skin and nasopharyngeal cancers. Hence the type of cancers seen in childhood is very different from those seen in adults.
In the bone marrow, plasma cells are a type of white blood cell. As part of the immune system, they aid in the fight against infection. When cancerous, these abnormal plasma cells spread throughout the bone marrow, leaving insufficient space to produce normal blood cells.
Multiple areas of the body contain bone marrow, including the spine, skull, shoulders, ribs, and pelvis. People over the age of 60 are more likely to suffer from this condition, and men are more likely to suffer from it. In the five years following diagnosis, myeloma has a survival rate of 51%.
Myeloma has no known cause. Several chemicals, high radiation levels (such as from working in a nuclear power plant) and viruses (such as HIV) are linked to an increased myeloma risk. The disease is not considered hereditary, so it is uncommon for more than one member of a family to be affected by it.
The following tests may be used to diagnose myeloma:
Blood and urine tests
Myeloma can be diagnosed using a variety of blood and urine tests. A blood test is performed to determine the amount and type of paraprotein in the blood. Myeloma cells produce paraproteins, which are abnormal antibodies. It is possible to test for the presence of Bence Jones protein in the urine, which is a paraprotein.
CT scans provide three-dimensional images that enable doctors to visualise a part of the body more closely or to identify areas of bone damage that may not be visible on an x-ray.
It is sometimes possible to detect myeloma in and outside of the bones using an MRI scan. Sestamibi scan and FDG/PET scan are less commonly used scans.
To determine if myeloma cells have caused any bone damage, X-rays are taken of the head, spine, ribs, hips, legs, and arms.
Bone marrow biopsy
Bone marrow aspirate and trephine biopsy are used to examine bone marrow cells. It is usually done with a local anaesthetic. A thin needle is used to remove a sample of bone marrow to examine under a microscope.
Through a bone marrow biopsy, cytogenetic tests are used to determine whether the myeloma cells have altered chromosomes, which are different from normal cells. Using this information can help determine the most effective course of treatment.
You may experience various emotions after receiving a myeloma diagnosis, including shock, anxiety, fear, and a sense of loss of control. All of these reactions are normal, and each experiences them differently.
It can also be challenging to decide what treatment to have and when treatment should begin. It is imperative to discuss the available treatments with your physician, as well as any possible side effects and practical considerations such as additional costs. This will enable you to make an informed decision. It would be best if you took as much time as possible before making a decision.
In early-stage myeloma, active monitoring involves regular check-ups when immediate treatment will not adversely affect the prognosis.
As part of the initial treatment, chemotherapy and other drugs, such as thalidomide and steroids, are typically administered.
Nasopharyngeal carcinoma is not commonly treated with surgery. For patients with minor local relapses, surgery serves as a salvage treatment.
Bortezomib, a drug that blocks protein breakdown within myeloma cells, causing them to stop growing and die, may also be used to treat the disease.
The mechanism of action of thalidomide is to block the blood supply to cancerous cells and to stimulate the immune system to attack myeloma cells. The medication is taken in the form of tablets. The drug lenalidomide, which is relatively newly developed, works similarly and is commonly prescribed to patients with relapsed myeloma.
Using steroids (corticosteroids) can modify the immune system's response, relieve swelling and inflammation, and actively destroy myeloma cells. Usually taken as tablets, corticosteroids are used alone or in conjunction with chemotherapy or other anti-myeloma agents.
A bisphosphonate drug is used to reduce bone pain and prevent further damage to the bone caused by myeloma cells. Additionally, they prevent dangerous increases in blood calcium levels.
A variety of symptoms of multiple myeloma can be relieved with radiation therapy (also known as radiotherapy), which uses x-rays to kill or injure cancer cells.
If the level of paraprotein in the blood is very high and interferes with blood circulation, plasma exchange may be used. This procedure removes some extra proteins from the blood. Through a needle in one arm, blood is redrawn. This blood passes through a separate machine, which then injects the healthy portion of the blood with the replacement plasma back into the other arm.
Palliative care may be discussed with you by your medical team in some myeloma cases. Palliative care aims to alleviate your cancer symptoms and improve your quality of life. It is also possible to reduce pain and manage other symptoms with palliative treatment and slow the spread of myeloma. Many treatment options are available, including radiotherapy, chemotherapy, and other medications.
Stem cell transplantation involves high doses of chemotherapy to destroy the bone marrow, followed by the transplantation of blood-forming stem cells to rescue the bone marrow and restore the blood cell count. Several stages are involved in this intensive form of treatment. It may take several months for the entire procedure to be completed, and some people are suitable for it.
It is common for people who undergo a stem cell transplant to receive their own previously collected stem cells (autologous transplant). It is sometimes necessary to transplant stem cells from another individual (allogeneic transplant).
A doctor cannot predict the exact course of a disease, as it will depend on the circumstances of each individual. Your doctor can provide you with a prognosis, as well as an indication of the likely outcome of your illness, based on the type of myeloma you have, the results of your tests, the rate at which the tumour is growing, as well as your age, fitness, and medical history.
Myeloma treatment is continually improving and can help control the disease, manage the symptoms, and improve quality of life, but it is not currently able to cure the condition. In most cases, once a person's myeloma has been controlled, they return to stable health. This may last several months or even years before further treatment is needed.
Myeloma cannot be prevented by any proven means. The risk of myeloma and related diseases has been linked to certain chemicals (e.g. dioxins), radiation, and viruses (e.g. HIV).
It is widely recognised that the SJMC Cancer & Radiosurgery Centre is an industry leader in cancer treatment. This facility was designed to provide patients with the highest care possible.
The goal of the centre's staff and doctors is to provide every patient with the highest quality of care. Whether patients seek preventive services or receive therapy, their ultimate goal is to enhance their emotional and physical well-being. Additionally, the facility offers support groups and other services that can ease the burden of living with cancer daily.