Before reading further on this topic, let’s consider a 70 year-old lady, who likes to eat crab. On visiting the clinic, she complains of some abdominal symptoms like constipation, nausea, and poor appetite. Besides, she has been feeling thirsty lately. She appears very pale and tired. And lastly, she has lower back pain which is constant in nature. Now, all these symptoms seem vague but they are all indirectly pointing to it being diagnosed as multiple myeloma.
What is Multiple Myeloma?
Multiple myeloma is the malignant proliferation of plasma cells. Now you might ask, what are plasma cells? Plasma cells derived from B cells which are produced in the bone marrow. After maturation, the B cells will eventually transform into plasma cells. Then, plasma cells carry out their function which is to produce antibodies in our body to protect us from infections.
What happens in Multiple Myeloma?
The disease starts with a mutation of the genes. This results in dysregulation and initiates further mutations too. After a few bouts of mutation, there is a loss of control over the production of plasma cells, and those that are produced are abnormal, in turn they produce abnormal antibodies. Most of the malignant plasma cells are accumulated in the bone marrow, which causes few of the consequences below.
What are the signs and symptoms of Multiple Myeloma?
One sole reason we mentioned the lady and the crab is because the mnemonic for this disease is CRAB!
As most of us know, our bones contain calcium. The malignant plasma cells will cause the reabsorption of calcium from the bones, in other words they remove calcium from the bones into your bloodstream. Hence, the elevated calcium level (hypercalcemia) in the blood test report. High calcium level can cause abdominal symptoms like nausea, vomiting, constipation, and poor appetite.
R- renal failure
The mutated antibodies are called paraproteins. They can precipitate and deposit in the kidneys and cause the disruption of normal function. Hence, the kidneys fail to retain water in the body, which then causes thirstiness.
A - anaemia
This is due to overcrowding of blood cells in the bone marrow. How so? Since there is an overload of the production of plasma cells in the bone marrow, the concentration of plasma cells increases, while the concentrations of red blood cells and platelets decrease. Red blood cells are oxygen transporters, without enough amount, one may feel dizzy and fatigue easily. He/she might even look pale. With the decrease in platelets, a condition known as thrombocytopenia, one will bleed or bruise easily. Sometimes the bleeding even takes a longer time to stop.
B - bone fractures
The malignant plasma cells are prone to reabsorb the calcium from the bones, thus increasing the breakdown of the bones, which is known as lytic bone lesions. This condition might lead to bone fracture due to its fragility, usually at the lower back, and more likely to break the spinal cord. This explains the old lady’s constant lower back pain!
I - infection
Lastly, with less production of normal antibodies, comes the less protection from infection.
With the few symptoms mentioned above, how do you know if you are just old or really having cancer?
You can do the following and just be sure!
- renal function test
- urine test
- bone scan
- blood test for complete blood count (anemia and thrombocytopenia)
- bone marrow biopsy
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What should you do?
First thing we all seek for after hearing about cancer is the treatment. Well in this case, symptomatic treatment is needed, which means the doctor treats according to the symptoms.
- To improve the kidneys function and to prevent further deterioration, one must have high fluid intake to replenish the water loss.
- If one has bone pain, pain killer should be given.
- The doctor might prescribe medication for hypercalcemia, and blood thinning.
- To pump up the low levels of iron in the blood, your doctor may suggest you to take more food with high iron value such as organ meats like liver, pumpkin seeds, nuts, fish and poultry, kale, eggs, and tofu.
Chemotherapy and bone marrow transplantation.
However, the need for treatment should be based on the individual’s biological status, the level of social support available, and the patient’s wish, but not on age alone. People in old age are less likely to tolerate well with treatment compared to younger teenagers.
While there is no cure for multiple myeloma, treatment helps to prolong survival time.
American Cancer Society
by Angie Loh
A medical student with nothing but passion and a pen. Poems and novels never fail to make me feel alive. I'm inspired to make the world a better place and fill it with a little bit more love. But first, where's my coffee? View all articles by Angie Loh.