Multiple Myeloma

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Symptoms, Diagnosis, & Risk Factors

Symptoms of myeloma come from the build-up of myeloma cells in the marrow, and from the M protein and chemicals that the myeloma cells release. People with asymptomatic myeloma may remain symptom-free for many years.

Once symptoms do begin, these symptoms are typical:

  • Weakness and fatigue caused by anemia
  • Kidney damage, which may cause swelling in the legs or weakness
  • Bone pain from build-up of myeloma cells, often in the back or ribs
  • Bone lesions, most often in the skull, spine or hips
  • Bone fracture, which may compress nerves or the spinal cord
  • Confusion, tiredness, weakness, dehydration, unusual thirst, nausea, Constipation or frequent urination caused by high levels of calcium in the blood (released when bone breaks down)
  • More frequent infection, or trouble recovering from infection
  • Excessive bleeding, including from minor injuries
  • The same symptoms can also be caused by other conditions. So it’s important to see a doctor if you have these symptoms.

Diagnosis

To find out whether you have myeloma, your doctor will first do a thorough physical exam and ask about your health history. Next the doctor will probably perform a series of blood tests to tell whether any blood cells are unhealthy and, if so, which type. Common blood tests to check for myeloma include the following:

  • Complete blood count, or CBC: to determine how many cells of each type of white and red bloods cells and platelets) are circulating in the bloodstream
  • Blood chemistry: to look for chemicals in the blood that can be abnormal in people who have myeloma
  • Protein testing: to tell whether there is abnormal protein in the blood or urine, what type and how much

For a clear diagnosis and to learn more about the prognostic features of the myeloma, your doctor will perform a bone marrow aspiration and biopsy. A small area of skin over the pelvis (the bone that makes up part of the hip) will be cleaned and numbed. Then a needle will be used to remove a small amount of bone marrow and a small piece of bone. The marrow will be examined under a microscope for involvement by the cancer. A biopsy also helps doctors tell the percentage of myeloma cells in your marrow.

The main way to tell whether myeloma has damaged or weakened your bones is to have X-rays taken. This is the standard imaging technique used in myeloma. If your doctor needs more detailed images, he or she may arrange for you to have other imaging procedures, such as magnetic resonance imaging (MRI), computed tomography (CT) scan, positron emission tomography (PET) scan.

Your doctor may also use the tests described on this page to monitor your condition and your response to treatment.

Risk Factors

Doctors do not know what causes the cellular changes that lead to myeloma. The disease occurs only in adults, seldom before the age of 40 and usually after age 65. It’s more common in men than women, and it’s twice as common in African-Americans as in white Americans. It’s less common in people of Asian or Hispanic descent.

Certain factors are linked to higher risk in some cases. For instance, exposure to some farming chemicals  or radiation may increase risk for myeloma. But in the vast majority of people, doctors are not able to link the disease to any particular risk factors.

Some families have more than one person with myeloma. But this is extremely unusual. So it does not appear that myeloma runs in families.