Concept and Etiology:Multiple Myeloma is considered a cancer of the plasma
cells because it consists of rapid overgrowth of abnormal plasma cells in the bone
marrow. This then causes an overcrowding in the bone marrow which in turn
crowds the blood forming cells. The body responds by excreting Bence Jones
proteins in the urine (Story, 2018, pg. 59). This condition causes the body to
deviate from the World Health Organizations definition of health because if
someone is diagnosed with this condition, they are no longer in a state of complete
physical wellbeing.
Classification:“The Revised International Staging System (R-ISS) is now used
more commonly to classify multiple myeloma. It defines the factors that affect a
person's survival of the disease. The R-ISS is based on data collected from people
with multiple myeloma from around the world. The system has 3 stages based on
the measurement of serum albumin, LDH, and serum β2-M and whether high-risk
chromosomes are found using the FISH test” (Cancer.net, N.d). Additionally, if
someone has a slight amount of abnormal plasma cells, without all the other
complications of multiple myeloma, they have what is called Monoclonal
Gammopathy, which is a noncancerous condition of increased plasma cells that has
a low m protein level. Furthermore, if someone has an even higher number of m
protein and plasma cells but still without several of the other symptoms of multiple
myeloma, they have what is called smoldering multiple myeloma. ;
Clinical Manifestations:
“The signs related to myeloma are described with the mnemonic acronym "CRAB,"
with each letter corresponding to a symptom:
;
Calcium levels are increased, which is known as hypercalcemia. This is defined as
a serum calcium level greater than 0.25 mmol/L above the upper limit of normal or
a level that is greater than 2.75 mmol/L.
;
Renal, or kidney, problems, identified as a creatinine level higher than 173
mmol/L.
;
Anemia is defined as having a low hemoglobin level, which is 2 g/dL below the
lower limit of normal or a hemoglobin level that is less than 10 g/dL.
Bone pain or lesions, including Lytic lesions (areas of bone damage), Osteoporosis
(thinning of the bones), or Compression fracture of the spine” (Cancer.net, N.d).
There are often very few symptoms of multiple myeloma, and when people do have
them, the disease has often progressed. Symptoms vary by person but can include
bone pain, especially in your spine or chest, nausea, constipation, loss of appetite,
mental fogginess or confusion, fatigue, frequent infections, weight loss, weakness
or numbness in your legs, or excessive thirst (Mayo Clinic, 2021).
Diagnostic Tests:Blood tests will be performed to check for M proteins, or to
check for;beta-2-microglobulin. Additionally, doctors will also order blood tests to
check kidney function, CBC, calcium levels and uric acid levels. Doctors will also
check a patient’s urine for the Bence Jones protein, doctors may also take a sample
of bone marrow through a bone marrow biopsy, one of tests done on bone marrow
cells is called FISH. Fluorescence in situ hybridization (FISH) can analyze
myeloma cells to identify gene mutations. Doctors may also order x-rays, MRIs,
CTs or PET scans to check for bone abnormalities which are commonly associated
with multiple myeloma.
;
;
;
References:
Mayo Foundation for Medical Education and Research. (2021, June 16). Multiple myeloma. Mayo
Clinic. Retrieved October 31, 2021, from
https://www.mayoclinic.org/diseases-conditions/multiple-myeloma/diagnosis-treatment/drc-
20353383.
Multiple myeloma - symptoms and signs. Cancer.Net. (n.d.). Retrieved October 31, 2021, from
https://www.cancer.net/cancer-types/multiple-myeloma/symptoms-and-signs.
Story, L. (2018). Pathophysiology: A Practical Approach (3rd ed.). Burlington, MA: Jones &
Bartlett Learning.
