Myeloma

Multiple myeloma is a type of cancer that occurs rather rarely, but it is one of the most common tumors of the bone marrow and the hematopoietic system. In Switzerland, around 620 people are diagnosed with this malignant plasma cell cancer every year; the exact causes are unknown. Most sufferers are older than 70 at the time of diagnosis. Thanks to medical progress, multiple myeloma cannot be cured, but it can be treated better and better. The therapy often slows down the growth of the cancer for a longer period of time and quality of life is maintained.

Overview: What is myeloma

Multiple myeloma is classified in the group of slow-growing non-Hodgkin’s lymphomas (NHL). Experts use the term non-Hodgkin’s lymphoma to describe all malignant diseases of the lymphatic system. The lymphatic system is part of the immune system and includes the lymphatic vessel system and lymphatic organs such as the thymus, spleen, tonsils, lymph nodes and bone marrow. Red and white blood cells are formed in the bone marrow, with the white blood cells having the task of defending against infection. Plasma cells develop from certain white blood cells, the B lymphocytes. They are an important part of the immune system because they help to fight infections by producing immunoglobulins, so-called antibodies. These antibodies can render pathogens harmless.

If the plasma cells degenerate or become malignant, they multiply unchecked and simultaneously produce large quantities of functionless and ineffective antibodies. The sick person becomes more susceptible to infections because the healthy immune system no longer works. The degenerated plasma cells are called myeloma cells; they form growths in many places in the bone marrow and increasingly displace the normal cells. Over time, this leads to various symptoms of the disease. At an advanced stage, myeloma also attacks the bone substance.

Myeloma: causes and risk factors

Scientists have not yet been able to clearly determine what causes myeloma. Environmental toxins, pesticides, heavy metals, solvents or asbestos are discussed as triggering factors. There also appears to be a link betweenobesity or chronic infections (HIV, hepatitis) and bone marrow cancer. Other risk factors for multiple myeloma are advanced age and male gender. Although a familial clustering can be confirmed, a genetic predisposition has not yet been proven. There are gene variants that appear to increase the risk of myeloma, but the correlations have not yet been fully clarified.

Monoclonal gammopathy of undetermined significance (MGUS) is seen as a precancerous stage of myeloma. In MGUS, non-functional antibodies are also formed, but not to the same damaging extent as in bone marrow cancer.

Symptoms: Myeloma

Myeloma can develop over a period of years without causing any clear symptoms of the disease. Signs such as tiredness, weight loss, night sweats, increased body temperature or an increased susceptibility to infections are not necessarily specific and can also be related to many other physical causes. However, to be on the safe side, you should contact us if you have any of these complaints and have the cause clarified. As with many malignant tumors, the earlier the disease is detected and treated, the greater the chances of treatment thanks to medical research. Diffuse signs of multiple myeloma can be:

• Frequent infections
• Fatigue
• Weight loss

Significant symptoms usually only become noticeable with advanced multiple myeloma. A whole series of conspicuous symptoms then appear, such as

• Bone pain, bone fractures
• Anemia, states of exhaustion
• Impaired kidney function, foamy urine
• Elevated calcium levels in the blood

Bone pain is the most common complaint associated with multiple myeloma. The growths in the bone marrow lead to back and bone pain, which is often misinterpreted as a sign of rheumatism or osteoporosis. Sudden fractures without real trauma also occur more frequently because the substance of the bone is increasingly attacked from the inside.

When the tumors spread in the bone marrow, they displace the blood-forming cells. The production of red blood cells decreases, resulting in paleness, tiredness and reduced performance. White blood cells are also produced less, the immune defense decreases and the corresponding consequences are a higher susceptibility to infections and diseases.

The antibodies produced in excess by the degenerated plasma cells (so-called paraproteins) are not functional and are excreted via the kidneys. Some sufferers complain of foaming urine. The dissolving bones release more calcium, which is distributed in the blood and also excreted in the urine. Paraproteins and calcium damage the fine tubules in the kidneys and their function suffers.

Myeloma – Diagnosis with us

Multiple myeloma is often discovered by chance during a blood or urine test. The first step in diagnostics is to confirm the suspicion. Then it must be clarified where exactly the myeloma is located and how far the disease has progressed. Used for diagnosis:

• Laboratory tests
• Bone marrow puncture
• Imaging techniques

The ineffective antibodies (so-called paraproteins) can be detected in the urine by laboratory tests and are an important indicator of the presence of multiple myeloma. The degenerated antibodies can also be detected in the blood, and the increased protein level indicates the stage of the disease. The blood count also examines whether the number of red and white blood cells and platelets is already reduced. The calcium content, kidney values and blood coagulation are also important parameters that indicate how far the myeloma has already spread.

Another examination is bone marrow puncture, in which a hollow needle is inserted into the bone marrow under local anesthesia to take a punch sample. The removed cells and tissue are examined microscopically to determine the exact proportion of malignant plasma cells.

Imaging techniques can be used to determine whether the myeloma has already attacked the bone structure. Even small signs of bone disintegration can be detected with a computer tomography (CT) scan. Magnetic resonance imaging (MRI) makes damage to the vertebral bodies visible. FDG-PET/CT can also be used to detect increased metabolism in affected bones and involvement of lymph nodes or organs.

Myeloma – stage of the disease

The findings are medically categorized into three stages, for which the levels of albumin and beta-2-microglobulin in the blood play a role. A high beta-2-microglobulin content is a sign of an advanced stage. The individual therapy plan depends on the classification.

Myeloma - prevention, early detection, prognosis

There is no way to prevent multiple myeloma. A healthy diet could protect against this to a certain extent. According to an Icelandic study, people with a high fruit consumption (at least three times a week) have a lower risk of developing multiple myeloma from the preliminary stage of MGUS.

With regular health checks, you yourself can contribute to possible early detection. This disease is usually discovered by chance during a blood count. And if you have diffuse symptoms, you can consult your family doctor and have the signs medically clarified.

The course of the disease depends on the stage at which it is diagnosed and treated. Thanks to modern treatment options, it is now possible to keep cancer growth in check over a longer period of time and maintain the quality of life of those affected.

Self-help groups

The exchange with people who are affected by the same disease can be a great support in coping with the disease. Advice on finding a suitable self-help group is available from Selbsthilfe Zürich. Self-Help Zurich and the University Hospital Zurich are cooperation partners in the national project “Health literacy thanks to self-help-friendly hospitals”.