Myeloma

This leaflet is intended as an introduction to myeloma. You can find out more about this disease by contacting the organisations listed at the end of the document.

What is Myeloma?

Myeloma is a cancer of the white blood cells.

White blood cells are responsible for the production of antibodies or immunoglobulins which circulate in the blood and attack any bacteria and viruses that invade the body. White blood cells are produced by one white blood cell dividing into two. This is normally a continuous but controlled process that takes place in the bone marrow, the spongy tissue inside bones.

In a cancer of the white blood cells, the reproduction of the cells becomes out of control, with abnormal cells multiplying, producing myeloma cells. These cells fill up the bone marrow interfering with the normal processes of the marrow such as the production of normal white cells, red cells and platelets.

In addition the myeloma cells have other effects. They produce abnormal antibodies that are unable to fight invading infections and affect the kidneys’ ability to filter waste products and excess water from the body. These abnormal antibodies slow the production of normal antibodies, making the body more vulnerable to infections.. The myeloma cells also invade the outer casing of the bone, causing holes to appear.

The cause of myeloma is not known. It is not, however, infectious and cannot be spread from one person to another.

Who gets myeloma?

Myeloma is not usually seen in younger people. It is most common in those of middle age – over 50 and the elderly. It is most unusual to see it in adults under 40 years of age.

What are the symptoms of myeloma?

The symptoms of myeloma are related to the effect of the abnormal cells on the body.

  • The most commonly reported is back pain which may affect the ribs, the neck and the pelvis.
  • The suppression of red blood cell production can cause anaemia which may appear as tiredness and lethargy.
  • Tiredness and lethargy may also be the result of a kidney problem as waste products build up in the body.
  • A patient may notice repeated minor infections like colds and coughs, because of the body’s impaired ability to fight off infection.
  • The erosion of bone will cause high blood calcium levels which can lead to nausea, constipation, loss of appetite and even depression and drowsiness.
  • Sometimes bruises can appear without injury and the patient suffers from gum bleeding and nose bleeds as the platelets in the blood that are responsible for clotting are not produced in sufficient numbers.

How is Myeloma diagnosed?

Myeloma is initially diagnosed by testing the blood and urine for the abnormal antibodies produced by the myeloma cells. These antibodies are called paraproteins. They are difficult to trace and the tests take about a week to complete.

If your tests suggest that you have myeloma, your hospital doctor will want to run more tests in order to be certain of the diagnosis and better plan any treatment that will be recommended to you. These will consist of:

  • X rays to assess your body for bone damage
  • A 24 hour collection of urine for a paraprotein called Bence Jones protein
  • A regular series of blood tests to measure the level of paraproteins and to monitor for anaemia or kidney failure
  • A bone marrow sample to see if it there are myeloma cells present in the marrow. This is done to confirm the diagnosis.

The tests may take some time to complete, and it may be several days or weeks before you get the final results.

How is myeloma treated?

There are two aims in the treatment of myeloma: to fight the disease and to control the symptoms of the disease.

Treatment of the disease may consist of one or a combination of:

  • chemotherapy which aims to destroy the myeloma cells using powerful drugs
  • steroids which in combination with chemotherapy are aimed at destroying the cancerous cells
  • interferon which helps to further control the disease after chemotherapy
  • radiotherapy which can destroy myeloma cells in specific locations in the bone, but not for the whole body

All these treatments have side effects which it is important to be aware of before starting treatment.

Treatment is tailored to the specific needs of a patient. Myeloma affects people differently and so different treatments are needed to match individual needs. Factors such as age, general health and the extent of the disease have to be considered and discussed with the patient..

Not everyone can be cured of myeloma, however the symptoms can be controlled and the spread of the disease slowed for a considerable time.

How are the symptoms controlled?

Unsurprisingly, treatment of the symptoms depends on the symptoms. The more common symptoms and their treatments are as follows:

  • Anaemia is treated with blood transfusions in order to stop you feeling tired and breathless
  • Infections are treated with antibiotics where possible. It is important to see your doctor at the first sign of any infection or fever
  • Pain is controlled using chemotherapy and radiotherapy. Painkillers are prescribed until these treatments have an effect.
  • Bone damage may need to be repaired with surgery in order to apply metal pins or plates for weakened bones
  • Kidney problems may require treatment from a kidney specialist. It is important to drink plenty to allow the kidneys to work properly.
  • Calcium in the blood is treated by giving patients extra fluids to enable the kidneys to filter out the calcium and flush it from the body in the urine and by drugs which slow down the rate of loss of calcium from the bone.

What other help is there?

Falling ill, waiting for a diagnosis, coping with a diagnosis and any treatment is difficult. Many people feel very helpless. There are things that can be done. Always try to find out about the illness. People cope far better when they know what they are facing. This is as true for the families of people with illnesses as it is for those with the illness.

There are support organisations locally and nationally dedicated to giving people with cancer the help they need, as much as anything to help themselves. Below are some useful contact addresses, they will be able to tell you about other groups that may be more local to you:

Tenovus Cancer Information Centre

College Buildings, Courtenay Road, Splott, Cardiff CF1 1SA

Welsh and English information service on all aspects of cancer, together with emotional support for patients and their families.

Tel: Freephone 0800 526527, 01222 497700

BACUP

3 Bath Place, Rivington St, London, EC2A 3JR

BACUP provides information on all aspects of cancer together with emotional support for patients and their families. They provide an information service free of charge to patients and families and a counselling service.

Cancer Information Service: London – 0171 613 2121

Out of London - Freephone 0800 181199

Cancer Counselling Service: 0171 696 9000

BACUP Scotland Cancer Counselling Service: 0141 553 1553

The Ulster Cancer Foundation

40-42 Eglantine Avenue, Belfast BT9 6DX

Has a helpline service and a resource centre. Runs support groups for patients and relatives.

Helpline: 01232 663439

Admin: 01232 663281


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