Multiple Myeloma – Symptoms and Staging
The symptoms of multiple myeloma range from mild fatigue to renal failure and paralysis. It is quite intriguing how an abnormality of a single type of cells can lead to such disastrous consequences. Apart from less morbid variants like an isolated plasmacytoma (single plasma cell tumor), multiple myeloma invariably leads to early death of an individual. Though, newer modalities of treatment claim to provide a complete cure, it is practically not demonstrated as yet. Thus, providing symptomatic relief to the patient is of utmost importance in treatment of multiple myeloma.
Symptoms of Multiple Myeloma
The common symptoms always present in multiple myeloma are fatigue and bone pains. The fatigue or a generalised feeling of tiredness is due to the lack of red blood cells which decreases the supply of oxygen to the tissues of the body. Bone pains are because of the loss of calcium from the bones due to the excessive action of osteoclasts. Bone pains can be felt in any bone of the body, but are commonly felt in the back bones, hip bone, and breast bone. Even trivial trauma, like a fall in the bathroom or fall from a bed, can collapse a back bone and cause compression of spinal cord, leading to full blown paralysis. Hence, bone pains in the back bones should never be neglected.
The increased antibodies and calcium in blood is taken to kidneys for excretion. The kidney is specialized to conserve proteins and calcium from leaving the body. So the calcium and antibodies are absorbed by the kidney cells. However, the accumulation of large quantities of calcium and antibodies causes destruction of kidney cells. This causes renal failure and leads to new symptoms like swelling of face and extremities, frequent urination, shortness of breath, loss of appetite, and so on.
The increased amounts of antibodies in blood affects the brain in the form of headache, confusion, and disturbances in vision. This is generally seen in advanced stages of the disease, especially after kidney function is greatly deranged. Once kidneys have failed, there is no route of exit to the antibodies present in blood. This is when they start precipitating at abnormal sites to cause interruption of several vital functions of the body. Hence, prompt evaluation and treatment of renal failure is essential to prevent serious complications like coma.
Staging of Multiple Myeloma
Staging gives an idea of the severity of multiple myeloma. It gives a fair idea about the prognosis (remaining life) of a person. It also provides a measure of the ability of a person to respond to a given treatment. Many times a multiple myeloma may not have any symptoms and is detected on routine blood tests for some other reason. This stage is called smouldering multiple myeloma. Treatment at this stage gives the most favourable results due to the relatively decreased number of cancerous cells. Even prevention of predictable complications becomes possible and suitable interventions can be planned in advance.
At present there are 2 staging systems which are commonly used for multiple myeloma, International Staging system (ISS) and Durie and Salmon system. Both these systems categorize patients into 3 stages with increasing severity. The treatment options offered to a person greatly depend on the stage of the disease as well as age at diagnosis. A physician may ask for several investigations to know or confirm the stage of the disease, like hemoglobin levels, X-ray, serum electrophoresis, and so on. Knowing the harmful effects of treatment options for multiple myeloma, it is prudent to spend enough time and money for the same.
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