Blood Tests
When you have
multiple myeloma, cancer cells crowd out healthy blood cells in your
body. Instead of making normal proteins called antibodies, they make
particles called M proteins. (The M stands for monoclonal.) To diagnose
you, your doctor will take a small amount of blood from a vein in your
arm. A lab then checks it for M proteins and another substance -- beta-2
microglobulin -- that are signs you have multiple myeloma.
Urine Tests
The proteins that
myeloma cells make don’t just show up in your blood. They can appear in
your urine as well, which gives doctors another way to diagnose the
disease. Plus, multiple myeloma can damage your kidneys, so your doctor
will want to check your pee for any sign they aren’t working properly.
Some of the tests require you to collect urine over a 24-hour period,
not give just one sample.
Skeletal Survey
In this test, your
doctor takes a look at all the major bones in your body using X-rays.
Multiple myeloma can cause bone problems, including pain, soft or
thinning bones, and fractures. X-rays can show that kind of damage. A
technician will show you how to position yourself and then take images
from different angles to get views of all your bones.
Bone Marrow Biopsy
Multiple myeloma
starts in bone marrow, the spongy tissue inside some bones. To test it,
the doctor uses medicine to numb the area near your pelvis, then he
takes a sample of the liquid inside your bone marrow using a needle that
goes into your pelvic bone. He also removes a sliver of bone and
marrow. Doctors will check the samples to see how your cells look and
whether you have too many plasma cells, a sign of multiple myeloma.
Magnetic Resonance Imaging (MRI)
This scan will show
your doctor if myeloma cells have replaced normal bone marrow. Your
doctor might also look for a tumor in the plasma cells of your blood
called a plasmacytoma. This type of imaging test is also good for
spotting spine fractures from the bone damage the disease can cause. For
an MRI, you’ll lie still inside a machine that looks like a large tube
while high-energy magnets and radio waves make pictures of your insides.
Positron Emission Tomography (PET)
A PET scan is
sometimes combined with another test, computed tomography, or a CT scan.
Before you lie inside the scanner, you’ll get a substance injected into
your veins through an IV in your arm or hand. It has a sugar and a
radioactive chemical. Cancer cells absorb more of this substance, so the
image gives your doctor a good idea of where those cells are in your
body.
Fat Pad Aspirate
Multiple myeloma
can make too many proteins build up in some organs, which can damage
them. It’s called amyloidosis. If your doctor suspects that’s happening
to you, the best way to find out is to check the fat around your belly.
The doctor puts a needle into your belly and removes a small bit of
tissue. (You’ll get numbing medicine first to make you more
comfortable.) Then, he’ll look at it under a microscope.
Molecular Tests
These highly
detailed looks at your bone marrow or tumor cells can identify
chromosomes, genes, proteins, and other things that are unique to your
cancer. The names of some of these tests are cytogenetics and
fluorescent in situ hybridization (FISH). You and your doctors can use
the information from these tests to decide on your treatment plan.
Watchful Waiting
Once you're
diagnosed, you and your doctor may decide that the best treatment for
your multiple myeloma is no treatment at all -- at least not right away.
This approach is also called “active surveillance,” and it’s
recommended if your disease is in the early stages and you don’t have
any symptoms. You’ll have checkups often to make sure your status hasn’t
changed. You might have blood and urine tests at these appointments.
Targeted Therapy
This treatment uses
drugs that go after your cancer’s specific genes, proteins, or the
tissue that helps it survive. This approach -- also called novel therapy
-- targets the cancer but limits harm to healthy cells. Drugs in this
group include those that stop myeloma cells’ growth in your bone marrow
and others that help your own immune system fight the cancer. You take
some of these drugs as pills; a needle is used to put others into a vein
in your arm.
Chemotherapy
This type of
treatment uses drugs to destroy cancer cells. You may take them in pill
form or through a needle in one of your veins. You’ll get a series of
these treatments on a set schedule, called a regimen. The length will
depend on the drugs you take and how severe your condition is.
Sometimes, doctors give a few chemotherapy drugs at once.
Radiation Therapy
Your doctor might
order this treatment to shrink a tumor quickly if it’s causing pain or
damaging a bone. High-intensity energy particles are beamed at your body
from a machine, and the radiation from the particles kills the cancer
cells. You’ll have a set number of treatments scheduled over a period of
time.
Corticosteroids
Drugs such as
prednisone and dexamethasone can boost your immune system, fight
inflammation, and work against the myeloma cells in your body. Your
doctor might have you take a steroid as part of your treatment plan. You
can take these drugs in pill form, or get them as shots into a vein in
your arm.
Stem Cell Transplant
This procedure
replaces your damaged bone marrow with special blood-forming cells
called hematopoietic stem cells. You can get them from a donor, or
doctors can collect your own cells ahead of time and give them back to
you. First, you’ll have chemotherapy to destroy the cancer cells in your
body. Then the transplant puts new cells in to start making healthy
bone marrow. The entire process takes several weeks. How much of that
time you spend in the hospital depends on the specifics of your
condition.
Bisphosphonates
Your doctor might
add one of these drugs to your treatment plan if your multiple myeloma
is causing a lot of bone problems. They can slow bone disease, prevent
fractures, and ease your bone pain. Two common drugs are pamidronate
(Aredia) and zoledronic acid (Zometa). You get them in a shot that goes
into a vein.
Surgery
Operations can help
deal with any bone fractures the disease causes -- they can reduce pain
or help you move around better. Multiple myeloma often affects the
spine. Nothing can undo the damage, but surgeons can help stabilize your
back. You may have a procedure called vertebroplasty or another called
kyphoplasty.
Multiple Myeloma -What Is It?
This blood cancer
forms when plasma cells -- white blood cells that fight germs -- start
to grow out of control. They’re found in marrow, the spongy tissue
inside some of your bigger bones. Sometimes these abnormal plasma cells,
known as myeloma cells, form a single tumor. That's called a solitary
plasmacytoma. If you have more than one of these tumors, it’s called
multiple myeloma.
Why Do You Get It?
Like many cancers,
multiple myeloma has no known cause. However, there are some things that
can raise your chances. Age plays a role: Most people who have it are
over 65. It’s twice as common in African-Americans and slightly more
likely to affect men than women. If someone in your family has it,
you're more likely to get it, too.
Can It Be Prevented?
You may wonder if
there was anything you could have done to avoid this cancer. The answer
is no. It doesn’t result from lifestyle choices, and you can’t discover
it with early screening tests. In fact, multiple myeloma is hard to find
early. Symptoms usually don’t show up until you’ve had it a while. But
scientists learn more about what causes it every year, and new drugs are
in the pipeline.
Symptom: Low Blood Counts
Plasma cells aren’t
the only ones formed in your bone marrow. Other white blood cells, red
blood cells, and platelets are created there, too. However, myeloma
cells can prevent bone marrow from making these healthy blood cells.
That can lead to:
- Anemia (low red blood cells), which can cause fatigue
- Thrombocytopenia (low platelets), which can cause bruising or bleeding
- Leukopenia (low white blood cells), which raises infection risk
Symptom: Bone Fractures
Myeloma cells are a
major enemy to bones. Believe it or not, your “old” bone is constantly
being dissolved by cells called osteoclasts. Meanwhile, cells known as
osteoblasts are making new bone. These things normally happen together.
Myeloma cells speed up the breakdown process, but not the buildup. The
result: Your bones get weak and can fracture easily.
Symptom: Infections
Plasma cells make
antibodies, which fight germs. If you get a cold, they can create an
antibody to attack the virus that’s making you sick. Abnormal plasma
cells don’t do that. Myeloma cells multiply and quickly crowd out your
healthy plasma cells, along with other white blood cells that protect
you from infection.
Other Things to Watch For
Multiple myeloma can lead to health problems like:
- Confusion and dizziness
- Numbness or muscle weakness in your legs
- Kidney problems
Because your bone
dissolves faster than normal, you may have a high level of calcium in
your blood. You might also feel really thirsty and dehydrated.
How Is It Diagnosed?
Blood tests can
check for many red flags, like low blood cell counts and high calcium
levels. X-rays can reveal bone loss. But the most important test for
this cancer is a bone marrow biopsy. A doctor will insert a special
needle into your bone and remove a tiny piece of tissue. He'll look at
it with a microscope to see if you have myeloma cells.
Should I Get Treatment?
It sounds crazy,
but if you don’t have symptoms yet -- a stage called smoldering myeloma
-- the doctor may tell you not to. Many people wait months or years
before they start treatment.
Are There Medications?
Yes. If you do need
treatment, there are many types. You might try traditional cancer drugs
like chemotherapy and corticosteroids. Or your doctor could try one of
several new options:
- Immunomodulating agents: affect your immune system, but doctors don’t know how
- Proteasome inhibitors: stop cells from breaking down proteins
- Monoclonal antibodies: attack cells that are a threat
Other Treatment Options
If you’re under 65,
or over 65 and otherwise healthy, your doctor may suggest a stem cell
transplant. Before it, you’ll get a high dose of chemo or radiation to
kill cells in your bone marrow. Then you’ll get a transplant of healthy
stem cells -- the ones that create new blood. You might get your own
cells. The doctor will call this an autologous transplant. Or they could
come from a donor. This is known as an allogeneic transplant.
Related Health Issues
Drugs and blood
transfusions improve anemia (low red blood cell counts) and the extreme
fatigue it causes. There’s a special procedure that thins your thickened
blood, a problem that can result in dizziness and confusion. Another
treatment, intravenous immunoglobulin (IVIG), will help your body fight
infections. You might also take drugs called bisphosphonates to lower
your risk of bone fractures.
Questions to Ask Your Doctor
It’s always a good idea to bring up concerns and ask questions at your office visits. Put these on your list:
- How can I stay healthy?
- Are there ways to ease my pain?
- What stage is my disease in, and what does it mean for me?
- Does my treatment have side effects?
- Should I get a second opinion?
- Should I join a clinical trial?
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Labels: antibodies, blood & urine tests, Chemo therapy, corticosteroid, CT, fat pad aspirate, kidneys, molecular test, MRI, Multiple Myeloma, novel therapy( targeted), PET scan, skeletal survey, stem cell transplant