Let's Talk About Multiple Myeloma Symptoms
It’s ironic (and unfortunate) that such a serious condition can be virtually symptom-free for a long time, making it tough to diagnose early. We asked the experts what to look for when signs of this blood cancer finally emerge.by Sunny Sea Gold Health Writer
What does it feel like to have multiple myeloma? Classic signs include bone pain and fractures. But clues to the disease can be subtle at first—fatigue, infections, and a sense that something’s not right. Of course, such nonspecific experiences could be caused by any number of situations, and it’s important to know that having one or more of the symptoms in this story doesn’t mean you have cancer. But it’s good to talk with your doctor, just to be sure.
Our Pro Panel
We went to some of the nation’s top experts in multiple myeloma to bring you the most up-to-date information possible.
Cindy Varga, M.D.
Medical Oncologist, Assistant Professor
Tufts Medical Center, Tufts University School of Medicine
Myo Htut, M.D.
Associate Clinical Professor of Hematology
City of Hope Comprehensive Cancer Center
Rebecca Silbermann, M.D.
Assistant Professor of Hematology/Medical Oncology
Oregon Health & Science University School of Medicine
Yes, and here’s why: MM can lead to a build-up of calcium in the blood known as hypercalcemia. This can cause confusion, weakness, drowsiness, lack of appetite, stomach pain and constipation, dehydration and thirst. Extremely high calcium levels can lead to a coma.
It can be. People with MM usually describe bone pain as deep—you can’t “make” it happen by pressing on the area. You might feel it constantly, or only if you move in certain ways. In severe cases, the pain may be sharp enough to prevent you from standing up.
Doctors aren't sure, but there are differences in the genes that turn cell growth on and off in people with MM. Also, normal cells have 46 chromosomes, but MM cancer cells are often either missing a part of one chromosome or have a switched-up order of chromosomes.
No, it’s not considered curable, yet. But it is treatable. Many new treatments have been discovered in the last decade, and some doctors are starting to call it a “chronic” condition that can be managed successfully for years.
What Is Multiple Myeloma, Exactly?
Multiple myeloma (MM) is a blood cancer that starts in the bone marrow. It happens when certain white blood cells known as plasma cells mutate and grow out of control. MM, also known as Kahler disease or plasma cell myeloma, is a pretty rare condition—the average American’s risk of getting at some point in their lifetime is just one in 132. (Compare that with the number of women who will develop breast cancer, which is one in 12.)
About 30,000 cases of MM are diagnosed every year, and there are an estimated 130,000 people living with it in the U.S. today.
Like any cancer, multiple myeloma is a serious condition. But people with the disease have a much brighter future today than they did even 10 years ago. Several new multiple myeloma treatments have been approved in the last decade, and survival rates keep going up. Today, the percentage of people who live at least five years after diagnosis is over 50%. For the 5% of people with multiple myeloma who are diagnosed at an early stage, the outlook is even better—their 5-year survival rate is over 70%.
Early Symptoms of Multiple Myeloma
Here’s the tricky thing about the beginning stages of multiple myeloma: There are often no noticeable symptoms at all. That’s frustrating, because when it’s caught early, treatment can be more successful.
Often, early MM is discovered because the numbers are “off” on blood tests that are being done for other reasons. As the disease progresses, however, there are some classic symptoms to keep an eye out for. Remember, having one or more of these symptoms doesn’t necessarily mean you have multiple myeloma. But you should talk to your doctor to get a better understanding of what’s going on.
What Are Multiple Myeloma “CRAB” Symptoms?
Some of the classic symptoms of multiple myeloma are described with the acronym CRAB, which stands for:
Calcium (increased blood calcium levels, also called hypercalcemia)
Renal (kidney) problems
Bone pain or damage
Read on for more details on these and other symptoms.
Multiple Myeloma Symptoms
People with MM develop tumors in their bone marrow, sometimes in more than one spot. As these tumors take up more and more space inside the bones, they prevent healthy bone marrow from doing its job of making infection-fighting white blood cells and red blood cells, which carry oxygen around the body.
This can lead to several symptoms:
Dizziness. If red blood cells in people with MM drop below a certain level, it’s known as anemia, a disorder that can cause dizziness, shortness of breath, and feelings of weakness due to lack of oxygen circulating in your body.
Infections. MM also slashes the number of white blood cells in your body. Having too few white blood cells—called “leukopenia”—can make you susceptible to infections like pneumonia. And if you do get an infection, a low white-blood-cell count makes it take longer for treatments to work.
Excessive bleeding. Even minor scrapes and injuries can cause a gusher, because MM results in lower-than-normal levels of blood platelets, which usually help clot the blood.
Confusion. MM can lead to a build-up of calcium in the blood known as hypercalcemia, which results in confusion, weakness, drowsiness, lack of appetite, stomach pain and constipation, dehydration, and thirst. Extremely high calcium levels can lead to a coma.
Slurred speech. Proteins released by your cancer cells can slow down blood flow to the brain. If that happens, it may cause slurred speech and weakness on one side of the body.
Swelling. Proteins released by the myeloma cancer cells can hurt the kidneys. Between 20% to 40% of people have some level of kidney failure by the time they’re diagnosed with MM. Symptoms of kidney failure include swelling in your ankles or feet, muscle cramps, lack of appetite, peeing too often or not enough, and itching.
Multiple Myeloma Symptoms and Your Bones
MM can trigger bone marrow cells to leach calcium from your bones, weakening them and causing soft spots called osteolytic lesions. Symptoms of bone damage may include:
Bone pain. Multiple myeloma can cause bone pain anywhere in the body, but most often in the back, hips, and skull. People with MM usually describe it as a deep pain—one that you can’t “make” happen by pressing on the affected spot. Some people feel this pain constantly; others only notice it when they move in certain ways. If the pain gets really severe, it may be sharp enough to prevent standing up or switching positions.
Broken bones. Leaching calcium from your bones can make them weak enough to break or fracture—even during minor stress or injuries.
Spinal damage. People with MM can have a chronic backache that lasts for months. (But so can a lot of people without cancer, so take this with a grain of salt.) If you experience severe and sudden back pain, it could be a sign of spinal cord compression (when spinal vertebrae get so weak that they collapse). See your doc right away, as the condition can be serious.
Numbness. If bones in your spine are affected by MM, they can start to press down on spinal nerves and lead to numbness and muscle weakness (usually in the legs). Toxins released by MM cancer cells can also damage nerves, leading to a tingling sensation in different parts of your body.
Depending on how much stress your bones are under, a surgeon may implant metal plates or rods to help shore them up.
Many people with MM also take bone-strengthening drugs known as bisphosphonates that can slow down the damage and relieve pain.
Radiation therapy is also used to shrink areas of cancer within the bone marrow. As the cancer cells die, your bones replace them with healthy tissue, making them stronger.
Diagnosing Multiple Myeloma
If you’re worried that you might have multiple myeloma, you should see your doctor right away. MM can be diagnosed using a few different tools, including a physical exam and a deep-dive into your symptoms. After that, there are several different tests that can be done, including blood tests and imaging.
Blood and Urine Tests
Myeloma cancer cells pump out an antibody called monoclonal immunoglobulin, or “M protein” that can be measured in blood and pee. (Once diagnosed, these tests can also be done to figure out if the disease is spreading or treatment is working.)
Your doctor can also test the blood or urine samples for other proteins that are potential markers of this blood cancer, such as immunoglobulin, serum albumin, beta-2 microglobulin, and proteins known as “free light chains.”
Experts don’t yet know which type of imaging is the best for diagnosing multiple myeloma—they all have pros and cons—so your doctor may want to employ a couple different tests to cover all the bases. These are a few of the common options:
X-ray. X-rays looking for bone damage are often the first step in imaging, since they’re relatively inexpensive and easy to get.
CT (computed tomography) scan. These computer-aided x-rays can show soft tissues and organs, not just bones, and create a 3D image of the inside of your body. (The injection of dye, sometimes used to create a more-detailed picture, is not used during a CT scan for multiple myeloma, because it can lead to kidney damage.)
PET (positron emission tomography) scan. Like CT scans, PET scans take pictures of your organs and tissues. By injecting a very small amount of a radioactive liquid into your blood, your doctor can see how much “activity” is going on in the concerning areas of the body. Active cancer cells suck up this substance more than other cells around them.
MRI (magnetic resonance imaging). MRIs use radio waves and a magnetic field and computer to make 3D images. These scans capture the bone marrow itself, so a doctor can assess how much of the normal, healthy marrow has been replaced by cancer cells. These tests can also pinpoint tumor size and nerve compression.
If blood tests and imaging suggests something’s up, your doctor may move on to other tests to confirm an MM diagnosis, figure out the disease stage, and decide on a course of treatment.
Bone marrow tests. Bone marrow is made up of liquids and solids. Bone marrow aspiration tests the liquid, and biopsy tests the solid. Both tests are done with a needle inserted into the bone, often the pelvic bone, and they’re often done at the same time.
Molecular testing. Detailed genetic testing of the myeloma cancer cells will tell doctors how aggressive the tumor is likely to be and can help determine the best treatments.
Reading all these symptoms can be a little scary, and in truth, multiple myeloma is a serious condition and if you think you could have it, you’ll want to see your doctor right away to find out what’s going on. Because symptoms don’t tend to show up until later stages of MM, the earlier you can get diagnosed and start treatment, the better.
But also, let’s breathe for a minute. Multiple myeloma is relatively rare. These symptoms are more likely to be caused by other, everyday things than cancer. Backaches are a common side effect of sitting too long at your desk or carrying a bit too much weight. Dizziness can be caused by low blood sugar or not eating enough for breakfast. Swelling in your feet could just be poor circulation.
You get the point. Don’t panic, but be smart: See you doc to rule out anything super serious—and if it does turn out to be MM, be grateful you caught it now so you can turn your energy toward treatment, where new therapies offer a lot of hope.
Multiple Myeloma Definition: Memorial Sloan Kettering Cancer Center. (2020). “Multiple Myeloma.” mskcc.org/cancer-care/types/multiple-myeloma
Multiple Myeloma Prevalence: American Cancer Society. (2020). “Key Statistics About Multiple Myeloma.” cancer.org/cancer/multiple-myeloma/about/key-statistics.html
Multiple Myeloma Prognosis: Multiple Myeloma Research Foundation. (2020). “Multiple Myeloma Prognosis.” themmrf.org/multiple-myeloma/prognosis/
Multiple Myeloma and Survival Rates: American Society of Clinical Oncology. (2020). “Multiple Myeloma: Statistics.” cancer.net/cancer-types/multiple-myeloma/statistics
Multiple Myeloma Symptoms: American Cancer Society. (2020). “Signs and Symptoms of Multiple Myeloma.” cancer.org/cancer/multiple-myeloma/detection-diagnosis-staging/signs-symptoms.html
Melanoma and Blood Cells: Multiple Myeloma Research Foundation. (2020.) “Symptoms, Side effects and Complications.” themmrf.org/multiple-myeloma/symptoms-side-effects-and-complications/
Myeloma and Bones: Memorial Sloan Kettering Cancer Center. (2020). “Bone-Related Problems in Multiple Myeloma.” mskcc.org/cancer-care/types/multiple-myeloma/multiple-myeloma-treatment/support-bone-related-problems
Multiple Myeloma and Kidneys: University of North Carolina School of Medicine Kidney Center. (2020). “Myeloma Kidney.” unckidneycenter.org/kidneyhealthlibrary/glomerular-disease/myeloma-kidney/
Multiple Myeloma Diagnosis: American Society of Clinical Oncology. (2020). “Multiple Myeloma: Diagnosis.” cancer.net/cancer-types/multiple-myeloma/diagnosis