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Multiple Myeloma

Multiple myeloma is a rare type of white blood cell cancer that develops in the plasma cells; an American’s lifetime risk of developing the disease is 1 in 132.

Multiple myeloma is a rare type of white blood cell cancer that develops in the plasma cells; an American’s lifetime risk of developing the disease is 1 in 132.

Overview

It’s hard to catch multiple myeloma early, because it is often asymptomatic until it has reached a later stage, or even may cause symptoms that initially appear to be caused by another disease1https://www.cancer.org/cancer/multiple-myeloma/detection-diagnosis-staging/detection.html

Traditional imaging tests used in the detection and analysis of multiple myeloma include x rays, CT scans, and MRIs, of which the former two expose you to radiation that can be damaging in the long run2https://www.fda.gov/consumers/consumer-updates/reducing-radiation-medical-x-rays 3https://www.fda.gov/radiation-emitting-products/medical-x-ray-imaging/what-are-radiation-risks-ct. Furthermore, MRIs show the most detailed images of the bone and is the only technique capable of showing images of the bone marrow4https://www.cancer.org/cancer/multiple-myeloma/detection-diagnosis-staging/testing.html.

Symptoms

If signs of multiple myeloma present, they may include5https://www.mayoclinic.org/diseases-conditions/multiple-myeloma/symptoms-causes/syc-20353378

  • Excessive thirst
  • Weight loss
  • Appetite loss
  • Nausea
  • Constipation
  • Bone pain, specifically in the chest or spine
  • Confusion/brain fog
  • Fatigue
  • Frequent infection
  • Numbness or weakness in the legs

Other signs could include6https://www.cancer.org/cancer/multiple-myeloma/detection-diagnosis-staging/signs-symptoms.html:

  • Conditions caused by low blood counts, including anemia, thrombocytopenia, and leukopenia
  • Hypercalcemia
  • Nerve damage
  • Kidney problems

If you are having any of the above symptoms you need to talk to a doctor about the appropriate diagnostic work up. The Ezra scan is a screening test for asymptomatic individuals and it is not designed to diagnose existing or suspected cancers.

Causes

It is difficult for researchers to pinpoint precisely what causes most multiple myeloma cases, though they do know that multiple myeloma originates in genetic changes, or mutations, found in the DNA of normal plasma cells. Sometimes, these mutations can occur in oncogenes or tumor suppressor genes, which are the genes in charge of when cells grow, divide, or die. Such mutations can at least in part be responsible for cancer and can be inherited from one’s parents or be picked up randomly during one’s life. Furthermore, some multiple myeloma risk factors are known to sometimes cause changes specifically in plasma cell DNA7https://www.cancer.org/cancer/multiple-myeloma/causes-risks-prevention/what-causes.html.

In about 50% of all multiple myeloma cases, chromosomal translocation is to blame. In other words, part of one chromosome has been switched with part of another chromosome, causing an oncogene to be turned on8https://www.cancer.org/cancer/multiple-myeloma/causes-risks-prevention/what-causes.html.

Some risk factors that could increase one’s likelihood of developing multiple myeloma include9https://www.cancer.org/cancer/multiple-myeloma/causes-risks-prevention/risk-factors.html:

  • Gender: the disease is slightly more common in men than in women
  • Race: for unknown reasons, the disease is more than twice as common in African Americans than in Caucasians 
  • Age: your risk increases with age; most individuals diagnosed with the disease are 65 or older.
  • Obesity: being overweight or obese increases your risk.
  • Having other plasma cell diseases: individuals with solitary plasmacytoma or monoclonal gammopathy of undetermined significance have a higher likelihood of developing the disease
  • Family history: the disease seems to sometimes run in families

Detection

Common methods to look for multiple myeloma include blood analysis, biopsies, and imaging tests. Blood tests can analyze levels of calcium, albumin, creatinine, and other electrolytes to get a hint as to whether multiple myeloma could be the culprit and how advanced your disease is, but cannot definitively prove whether or not you have cancer. Your doctor may also recommend a bone marrow biopsy. During a biopsy, your doctor will take a sample of your bone marrow to check if it contains too many plasma cells, which is a sign of multiple myeloma. These cells will also be analyzed in the lab for their shape, size, and appearance. Finally, common imaging tests include bone x rays, CT scans, and MRIs; x rays and CT scans, however, expose you to potentially harmful radiation10https://www.fda.gov/consumers/consumer-updates/reducing-radiation-medical-x-rays 11https://www.fda.gov/radiation-emitting-products/medical-x-ray-imaging/what-are-radiation-risks-ct. All three imaging techniques can reveal damage done by multiple myeloma, but MRIs also show detailed pictures of the body’s soft tissues, and can therefore provide finer images of the bone and bone marrow than x-rays can12https://www.cancer.org/cancer/multiple-myeloma/detection-diagnosis-staging/testing.html.

Diagnosis

If you have multiple myeloma, you will likely be diagnosed based on a physical exam, symptoms you have presented with, as well as tests you’ve undergone. A definitive multiple myeloma diagnosis is only reached once:

  1. A plasma cell tumor is proven via biopsy OR
  2. A patient presents with at least 10% plasma cells in the bone marrow AND at least one of the following: 
    • Imaging studies have shown holes in the bones from tumors
    • Anemia
    • High blood calcium levels
    • Poor kidney function
    • 60% or more plasma cells in the bone marrow
    • An increase in one type of antibody light chain in the blood such that one type is 100 times more common than the other

(Source)

Upon diagnosis, physicians traditionally perform further analysis to assign cancers a stage. This helps them conceptualize how severe a case is, and come up with the best treatment plan possible. The staging system used for multiple myeloma ranges from Roman numerals I-III, with III being the most severe. A patient’s stage is determined based on their cancer’s cytogenetics and their blood counts of certain substances that are often skewed in multiple myeloma13https://www.cancer.org/cancer/multiple-myeloma/detection-diagnosis-staging/staging.html.

Treatment

The best treatment for multiple myeloma depends on the nature of the disease and how far it has spread. Treatment options may include: radiation, surgery, a stem cell transplant, or drug therapy14https://www.cancer.org/cancer/multiple-myeloma/treating.html.

Please consult with a physician on treatment options as necessary.

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