Multiple myeloma is a blood cancer that spreads mainly to the bones. It represents 1% of all types of cancer and primarily affects those over 60 years of age. Know its symptoms and treatment.

Multiple myeloma is a tumor derived from plasma cells, a type of blood cells in the bone marrow (the tissue found inside of the bones) that are responsible for producing antibodies that serve to fight germs. In this disease, the plasma cells undergo an abnormal transformation process that increases their proliferation and invasion capacity, which can cause their dissemination, mainly to the bones. However, it can affect any other part of the body less frequently.

The plasma cells of multiple myeloma produce a protein that is detected in the blood and is called the ‘ monoclonal component. ‘ The invasion and proliferation of myeloma cells, as well as the production of the monoclonal component, cause the main symptoms and complications of this tumor, such as fatigue, bone pain, bone fractures, anemia, kidney failure, increased blood viscosity, and more susceptibility to infections.

Multiple myeloma represents 1% of all types of cancer. Its incidence in Europe is 4.5 to 6 cases per 100,000 inhabitants per year and mainly affects people over 60 years of age, since the chances of suffering from this disease increase with aging. It is estimated that less than 1% of cases are diagnosed in those under 35.

Types of multiple myeloma

Different stages can be distinguished in the progression of multiple myeloma:

• Monoclonal gammopathy of uncertain significance (MGUS): characterized by detecting the ‘monoclonal component’ in the blood without evidence of tumor mass. Multiple myeloma patients have MGUS, but not all people with MGUS have multiple myeloma, although they can develop this cancer or other diseases over time.
• Symptomatic multiple myeloma: derived from the effect of the tumor mass or its products, and characterized by bone pain, fractures, increased blood calcium, anemia, and kidney failure.

Additionally, single or multiple plasma cell tumors (plasmacytomas) can occur without systemic disease development.

There is no known single risk factor to which multiple myeloma’s presence and development can be attributed. Still, it has been suggested that environmental exposure to herbicides, insecticides, benzene, and radiation may contribute to its occurrence.

Regarding genetics, people with a direct family history – a sibling or a parent – can be up to four times more likely to have multiple myeloma. Still, most patients have no affected relatives, so it is not considered a hereditary disease.

People who get myeloma are acquiring genetic alterations throughout their lives, which favor transforming plasma cells into malignant cells, which causes this cancer. Additionally, patients diagnosed with other plasma cell diseases, such as monoclonal gammopathy of uncertain significance (MGUS) or solitary plasmacytoma (a single plasma cell tumor), are also more likely to develop multiple myeloma.

A study by the American Society Against Cancer indicated that overweight or obese also increased the risk of developing myeloma. At the same time, so far found no link between exposure in the workplace and the risk of this cancer.

Symptoms of multiple myeloma

The multiple myeloma is manifested by the presence of the tumor mass and producing the monoclonal component and other substances. About three out of four patients have bone pain, especially in the rib area and the spine. The deficiency of red blood cells and the alteration of platelets’ normal functioning usually cause other of the usual symptoms in patients with this type of cancer.

The main signs and symptoms of multiple myeloma are as follows:

• Anemia manifested mainly with paleness, fatigue, palpitations, dizziness.
• Bone pain, which usually starts in the spine and ribs.
• Fractures, osteoporosis, destruction of bone tissue (osteolysis), increased levels of calcium in the blood. These problems are usually present in most patients when receiving the diagnosis and typically affect mainly the pelvis, skull, sternum, ribs, spine, or femur.
• Low platelets can lead to bleeding (for example, in the gums or nose) and bruising.
• Leukopenia (lack of normal white blood cells).
• Decreased kidney function due to the deposition of abnormal protein.
• Infections because abnormal plasma cells do not fulfill their function of protecting the body against germs.
• Kidney damage can lead to kidney failure.
• Light chain amyloidosis, which accumulates in the tissues, can generate amyloid protein, which interferes with the organs’ functioning. In the heart’s case, it can cause irregular palpitations and weaken it, leading to heart failure.

David Cury