Reviewed: Prof. Miles Prince MBBS (Hons) MD MRACMA FRACP FRCPA, Chair, Clinical Cancer Services; Professor, University of Melbourne; Director, Centre For Blood Cell Therapies, Peter Mac
Multiple myeloma affects the bones, bone marrow and kidneys. It may cause pain in the back, pelvis and ribs, easily broken bones, easy bruising, anaemia and bleeding from the nose or gums. People with multiple myeloma are more likely to get infections. Other symptoms that are less common are kidney failure and weight loss.
Your doctor will examine you and refer you for tests to see if you have multiple myeloma. This can be a worrying and tiring time, especially if you need to have several tests. If the tests show you have or may have multiple myeloma, your doctor will refer you to a specialist, who will advise you about treatment options.
You should expect to be cared for by a team of health professionals from the relevant major fields (see following list). Ideally, all your tests and treatment should be available at your hospital. This may not be possible in some non-metropolitan areas.
Specialists and other health professionals who care for people with multiple myeloma include:
If your doctor thinks that your symptoms may be due to multiple myeloma, a number of tests can be done to find out for certain. These tests will also find out if the cancer has spread. You may have some or all of the following tests.
You may have a blood test to check your levels of blood cells, which can be affected by multiple myeloma. Also, your blood may be checked for the presence of M-protein, which is made by multiple myeloma cells. Blood tests can show calcium levels (and whether you have hypercalcaemia) and check for kidney problems.
A urine test will check for M-protein (Bence-Jones protein), and see if your kidneys have been affected.
You may have bone x-rays to test for thinning of the bones (osteoporosis) or evidence of multiple myeloma in the bone.
A bone marrow biopsy may be done to look for multiple myeloma cells. A small amount of fluid is collected from the bone marrow with a syringe, and a small core of bone marrow is also removed. The biopsy is done under local anaesthetic. You may also have a sedative to increase your comfort. The samples are then examined under a microscope.
The tests described on the previous pages show whether you have cancer. They will also show the extent of the cancer in your body. This helps your doctors ‘stage' the disease so they can work out the best treatment for you.
Generally, multiple myeloma is divided into three stages, which indicate the effect the disease is having on the body and how quickly or slowly it may develop. Two staging systems are used in Australia. The International Staging System is a newer staging system, and looks at the levels of the blood proteins beta-2 microglobulin and albumin.
How the International Staging System stages multiple myeloma
Stage 1: The beta-2 microglobulin is less than 3.5 mg/dL and the albumin level is greater than or equal to 3.5 mg/dL.
Stage 2: The beta-2 microglobulin level and the albumin levels are less than 3.5, or the beta-2 microglobulin level is between 3.5 and 5.5 mg/dL.
Stage 3: The beta-2 microglobulin level is greater than or equal to 5.5 mg/dL.
The Durie-Salmon System is also used, especially for people in clinical trials. It looks at how the cancer is affecting the red blood cells, bones, and calcium and paraprotein levels.
How the Durie-Salmon System stages multiple myeloma
Stage 1: An early stage. The number of red blood cells is either normal or only slightly reduced. The amount of calcium in the blood is normal. There are low levels of paraproteins in the blood or urine. The bones either appear normal or there is a single plasmacytoma (cancer of the plasma cells). There may be no symptoms.
Stage 2: The multiple myeloma is between stage 1 and stage 3.
Stage 3: A more advanced stage. It has caused one or more of the following:
In the Durie-Salmon System, Stages 2 and 3 are further divided depending upon how well the kidneys are working. For example, you may have stage 2A or 3B, where: