Patients often have no symptoms for years, until the disease has progressed to an advanced stage.
- Stage I disease. This is the least serious type of multiple myeloma, during which patients have little or no bone damage, and have normal calcium levels in the blood. They are less likely to experience severe pain or kidney problems.
- Stage II disease. Patients with stage II disease have intermediate disease; that is, their symptoms are more pronounced than those in stage I but less severe than those in stage III.
- Stage III disease. In this most serious type of disease, large amounts of calcium and abnormal proteins are present in the blood, several areas of bone have been destroyed, and the hemoglobin level is low. Patients with stage III disease are likely to have severe bone pain and malfunctioning kidneys, as well as a greater chance of getting an infection.
Myeloma has symptoms similar to those of several other conditions Table 01. Symptoms can develop when multiple myeloma causes problems at the tumor sites and throughout the body. Patients often report back pain, fatigue, and lightheadedness when standing up. Because myeloma damages bones, pain is common at the tumor site. The disease can also cause impaired kidney function and decreased production of other necessary blood cells.
Most patients have initial symptoms of pain in the back and rib bones. Long-standing unexplained back or rib pain that does not respond to rest or anti-inflammatory drugs may indicate the need for additional testing.
Bones that are weakened by multiple myeloma are more easily broken, even without a serious fall or injury.
Patients may also have symptoms related to renal failure, anemia, increased calcium levels, or infection. Thirst and nausea can result from high calcium levels. Platelet abnormalities can cause patients to bleed easily. In addition, as M proteins interfere with normal clotting and tumor cells affect platelet production, little red spots may develop on the skin. M proteins can also cause painful nerve damage.
Table 1. Symptoms of Multiple Myeloma
Bone pain (usually involving the back and ribs) Recurrent bacterial infections Weakness, fatigue, lethargy Fever Bleeding Nausea Thirst Carpal tunnel syndrome Peripheral neuropathy
Patients with myeloma often develop anemia, a condition characterized by a reduction in the number of red blood cells.
Anemia occurs when tumor cells replace normal bone marrow tissue, and when kidney failure leads to a disappearance of or reduction in erythropoietin. About 80% of patients with multiple myeloma are already anemic when they learn that they have cancer.
Several factors can predispose a person to multiple myeloma. Multiple myeloma usually occurs in people over the age of 40. African-Americans are at greater risk than Caucasians, and men are at greater risk than women. Heredity may also play a role; having a sibling or parent with the disease may increase risk. People exposed to insecticides, herbicides, and other chemicals are thought to be at increased risk for multiple myeloma, but results of studies have been inconsistent. Farmers, leather workers, woodworkers, and petroleum industry workers may have a greater risk for the disease. Long-term exposure to radiation, such as in a nuclear power plant, may increase a person’s risk. Patients with immune abnormalities of the plasma cells (called monoclonal gammopathy of undetermined significance, or MGUS) or single tumors in the bone marrow and other tissues (solitary plasmacytomas) may eventually develop multiple myeloma (multiple myeloma will develop in about 20% of patients with MGUS). Herpes virus-8 (HHV8), which is associated with HIV-related Kaposi’s sarcoma, has been found in patients with multiple myeloma, but doctors do not yet know whether this finding is significant.
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