Here are some answers to frequently asked questions about multiple myeloma.
Q: What is multiple myeloma?
A: Multiple myeloma is a kind of cancer that begins in plasma cells, a type of white blood cell. These cells make proteins called antibodies (immunoglobulins) to help the body fight infection. When plasma cells grow out of control, they build up either in the bone marrow or in organs. The tumors that are formed can destroy normal bone tissue. This can cause bone pain and sometimes fractures. The tumors can also cause large amounts of calcium to leave the bones and enter the blood, which can also cause problems, such as confusion, pain, and kidney failure.
Cancerous plasma cells can also crowd the bone marrow, preventing the healthy cells from working normally. That means people with multiple myeloma may not make enough white and red blood cells. They may also have fewer platelets, which are needed for clotting blood. Plus, since the plasma cells help the body fight disease, if a group of them is cancerous, the body is not as able to fight infection. People with multiple myeloma are at greater risk of getting infections.
Cancerous plasma cells can also make large numbers of antibodies, which can travel through the blood and damage organs, such as the kidneys.
Q: Who gets multiple myeloma?
A: Most people who get multiple myeloma are 65 or older. It is rarely seen in people younger than age 35. More men get it than women, and more African-American people get it than white people. Multiple myeloma is a relatively uncommon cancer. Doctors are not sure why one person gets it and another one does not.
Q: What are the risk factors for multiple myeloma?
A: Certain factors can make 1 person more likely to get multiple myeloma than another person. These are called risk factors. Some risk factors have been identified, but these only slightly raise a person’s risk of getting the disease. Doctors have identified some risk factors for multiple myeloma, but they are not sure how much a part these play in someone getting the disease. Here are some things that may increase the risk for multiple myeloma:
Age. Less than 1% of cases are diagnosed in people younger than age 35.
Gender. Men are slightly more likely to develop multiple myeloma.
Race. African-Americans are more likely to have this cancer.
Exposure to radiation. This accounts for a small number of cases.
Family history. Having a sibling or parent who has it may increase your risk.
Exposure to chemicals. Your risk may increase if you work with certain substances, such as petroleum products.
Certain health conditions. Being overweight or obese may increase your risk.
Certain plasma cell diseases. These include solitary plasmacytoma and monoclonal gammopathy of undetermined significance (MGUS). These disorders are considered "precursors" to myeloma and may or may not evolve into multiple myeloma.
Q: What are the symptoms of multiple myeloma?
A: A person’s symptoms depend on how advanced the cancer is. Some people with early multiple myeloma have no symptoms. Instead, it is found during routine blood or urine tests. People may feel pain in their bones, often in their back or ribs. Some people may get broken bones since multiple myeloma causes the bones to weaken. Other people feel tired and weak, they may have more infections than usual, and they may lose weight or have other problems. Some people may develop evidence of kidney failure. These symptoms do not mean that a person definitely has multiple myeloma. Other things could be causing them. People should talk with their doctor if they are having any of these symptoms.
Q: How is multiple myeloma diagnosed?
A: The doctor asks questions about a person’s symptoms, medical history, family history, and history of exposures. The doctor also does a physical exam to check for signs of the cancer. The doctor may order many of these tests to help make the diagnosis:
Computerized tomography (CT scan)
Magnetic resonance imaging (MRI scan)
Positron emission tomography (PET scan)
Biopsy, if the tumor is in soft tissue
Bone marrow aspiration and biopsy
Q: Should everyone get a second opinion for multiple myeloma?
A: Many people with cancer get a second opinion from another doctor. There are many reasons to get one. Here are some of those reasons:
Not feeling comfortable with the treatment decision
Being diagnosed with a rare type of cancer
Having several options for how to treat the cancer
Not being able to see a cancer expert
Many people have a hard time deciding which treatment to have. It may help to have a second doctor review the diagnosis and treatment options before starting treatment. It is important to remember that in most cases, a short delay in treatment will not lower the chance that it will work. Some health insurance companies even require that a person with cancer seek a second opinion, and many other companies will pay for a second opinion if asked.
Q: How can someone get a second opinion for multiple myeloma?
A: There are many ways to get a second opinion.
Ask a primary care doctor. He or she may be able to suggest a specialist. This may be a surgeon, medical oncologist, or radiation oncologist. Sometimes these doctors work together at cancer centers or hospitals. Never be afraid to ask for a second opinion.
Call the National Cancer Institute’s Cancer Information Service. The number is 800-4-CANCER (800-422-6237). They have information about treatment facilities. These include cancer centers and other programs supported by the National Cancer Institute.
Seek other options. Check with a local medical society, a nearby hospital or medical school, or a support group to get the names of doctors who can give you a second opinion. Or ask other people who’ve had cancer for their recommendations.
Q: How is multiple myeloma treated?
A: Some people with early (often called "smoldering") multiple myeloma may not need treatment right away. Their disease is closely monitored, and treatment is started if they have symptoms or if there are signs that the disease is progressing. Treatment for multiple myeloma is mainly systemic. These kinds of treatments kill or control cancer cells all through the body. Doctors almost always use chemotherapy or other drugs to treat people with multiple myeloma. They may also use bone marrow transplants or peripheral blood stem cell transplants.
Local treatments fight cancer cells in one area. Radiation is an example. Doctors use it to control bone pain or prevent breaks.
Q: What’s new in multiple myeloma research?
A: Cancer research should give you hope. Doctors and researchers around the world are learning more about what causes multiple myeloma, and are looking for and studying ways to prevent it. They are also finding better ways to detect and treat this cancer.
Studies are being done to improve survival in people with multiple myeloma who are treated with high-dose chemotherapy and stem cell transplants.
Researchers have found that cells in the bone marrow known as stromal cells promote the growth of multiple myeloma. Drugs such as thalidomide and lenalidomide can prevent this as well as kill myeloma cells. These drugs are now often part of the treatment for multiple myeloma. Other new types of drugs are being studied as well.
Q: What should I know about clinical trials for multiple myeloma?
A: Clinical trials are studies of new kinds of cancer treatments. Doctors use clinical trials to learn how well new treatments work and what their side effects are. Promising treatments are ones that work better or have fewer side effects than the current treatments. People who participate in these studies get to use treatments before the FDA approves them. People who join trials also help researchers learn more about cancer and help future people with cancer.