The symptoms of multiple myeloma cancer

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Multiple myeloma may not always cause symptoms, particularly in the early stages of the disease.

If people do have symptoms, they may include:

• bone pain, which commonly affects the ribs, spine, and pelvis
• fractures, due to weakened bones
• anemia, due to low red blood cell count, which can cause fatigue, weakness, shortness of breath, and dizziness
• changes in urination, such as less urine output, which can be a sign of kidney damage
• increased bleeding or easy bruising, due to low platelet counts
• frequent infections, due to low white blood cell count

The bone damage that may occur with multiple myeloma can lead to hypercalcemia, which is an excess of calcium in the blood.

Severe hypercalcemia can be dangerous, so people should consider notifying their doctor immediately if they experience symptoms such as:

• increased thirst
• loss of appetite
• increased urination
• confusion or difficulty thinking
• restlessness
• nausea and vomiting

Although experts are not sure what causes multiple myeloma, certain factors may increase a person’s risk of developing the disease. These factors include:

• being age 65 years or older
• being male
• race, as multiple myeloma is more common in African Americans than white Americans
• having a family history of multiple myeloma
• having obesity or being overweight
• having other plasma cell conditions, including monoclonal gammopathy of undetermined significance (MGUS) and solitary plasmacytoma

If multiple myeloma does not cause symptoms, a doctor may identify the condition through a routine blood or urine test. People with multiple myeloma have a higher-than-normal level of M protein in the blood.

Doctors may use a variety of tests to diagnose multiple myeloma and determine the stage of the cancer. These tests may include:

• complete blood count, to check white blood cell, red blood cell, and platelet levels
• blood chemistry tests, to check levels of certain substances that may indicate myeloma, such as high calcium levels, low albumin levels, and high creatinine levels
• blood test to measure lactic dehydrogenase, as high levels may indicate a more advanced stage of multiple myeloma
• urine tests, to check myeloma protein levels
• quantitative immunoglobulins and electrophoresis, which measure specific types of protein in the blood
• bone marrow biopsy or aspiration, which involves taking a sample of liquid bone marrow or bone from the pelvic bone to examine under a microscope for abnormal cell changes
• fine needle aspiration biopsy, which involves using a fine needle to remove a small tissue sample from a lymph node or tumor
• core needle biopsy, which involves using a larger needle to remove a bigger tissue sample
• imaging tests, such as CT, MRI, or PET scans, to examine areas that may be cancerous or check how far the cancer has spread
• bone X-rays, to examine bone health

People with early stage multiple myeloma or multiple myeloma that does not cause any symptoms may not require treatment straight away.

Doctors refer to this type of multiple myeloma as smoldering multiple myeloma (SMM).

SMM does not cause damage to the bones or organs, and people still have normal blood counts, calcium levels, and kidney function. Doctors will carefully monitor the condition to see whether it turns into multiple myeloma.

Treatment for multiple myeloma with symptoms may depend on the age and overall health of the person, which determines whether they are eligible for a stem cell transplant.

Doctors usually carry out multiple myeloma treatment in stages. The first stage aims to reduce the amount of multiple myeloma in the body and may include:

• chemotherapy
• targeted therapy, with medications such as bortezomib, carfilzomib, or daratumumab
• immunotherapy, with medications such as lenalidomide
• corticosteroids

The second phase of treatment aims to destroy any remaining multiple myeloma cells.

People who are eligible may have a stem cell transplant, which could be one of the following:

• one autologous stem cell transplant, which uses healthy stem cells from a person’s own blood or bone marrow
• two autologous transplants, after which people will have a third autologous transplant or an allogeneic transplant, which uses blood or bone marrow from a donor
• one allogeneic stem cell transplant

After the initial phases of treatment, people may then require maintenance therapy to keep multiple myeloma in remission. This may include:

• chemotherapy
• immunotherapy, with lenalidomide
• corticosteroids
• targeted therapy, with bortezomib or ixazomib

People with no symptoms may not require treatment. SMM may take months or years before it causes symptoms, or in some cases, it may never develop into active multiple myeloma.

According to the Multiple Myeloma Research Foundation, multiple myeloma can be a manageable condition. Certain factors may affect a person’s outlook, such as:

• whether they have symptoms
• their age and overall health
• the stage of multiple myeloma
• how fast-growing the cancer is
• how far the cancer has spread in the body
• how the cancer responds to treatment

Multiple myeloma occurs when plasma cells in bone marrow become cancerous, which leads them to grow uncontrollably and crowd out other healthy cells.

People with multiple myeloma may not have any symptoms, or they may experience bone pain, fatigue, frequent infections, and increased bruising or bleeding.

Treatment for multiple myeloma will depend on the symptoms present and a person’s overall health. Treatment may include drug therapies and stem cell transplant.