Myeloma

There's more than one type of myeloma. Each type takes its name from the abnormal immunoglobulin (paraprotein) that the myeloma cells make. The types may cause different symptoms, but doctors usually treat them in the same way.

Some other conditions also affect plasma cells, and these can sometimes turn into myeloma.

Myeloma may not cause any symptoms in its early stages. Sometimes it's found after a routine blood test, before you've noticed anything wrong. In other cases it's found after you go to a doctor or to hospital with symptoms.

Symptoms can be vague, but you should see a doctor if you notice any of the following:

• fatigue
• drenching night sweats
• rash or itchy skin that is unexplained
• paleness
• bruising or bleeding with no obvious cause
• losing weight without trying
• new shortness of breath
• infections that are persistent or keep coming back after treatment
• pain in your bones or abdomen (tummy)

Myeloma can also cause symptoms because it has damaged the bones. This can include bone thinning and sometimes fractures. Bone damage can also lead to high levels of calcium in the blood, called hypercalcaemia.

If the kidneys are affected, myeloma can cause symptoms too. These include feeling tired or confused and having problems peeing.

In most cases these symptoms will be a sign of something less serious than cancer. Still, if you have unusual or persistent symptoms, it's always best to see a doctor and get checked as soon as possible.

There are different ways of managing myeloma symptoms.

Myeloma can be diagnosed in different ways. Some people see their doctor because of symptoms such as:

• bone pain
• tiredness
• having infections one after the other (recurrent infections)

The doctor may arrange some blood tests or scans. If necessary, they will then refer you to a doctor who specialises in blood conditions (a haematologist) at the hospital. The haematologist can arrange more tests and treatment.

Other people are diagnosed with myeloma after going into hospital with more severe symptoms. These can include:

• being very unwell with an infection
• bone problems
• spinal cord compression
• kidney problems

At the hospital, the haematologist will examine you and arrange more tests for myeloma.

Your blood can be tested for several different things. With myeloma, these tests help doctors diagnose the condition and keep track of it over time.

If you have myeloma, you may be asked to give samples of your urine. The samples are used to test for Bence Jones protein in your urine, and to check how well your kidneys are working.

Sometimes you may need to take a container home and collect all your urine over 24 hours. The nurses will explain how to do this test.

A bone marrow biopsy is a test where a doctor takes a sample of cells from your bone marrow, which is where your blood cells are made. The sample goes to a laboratory, and it's checked there for myeloma cells in the bone marrow.

If myeloma cells are found, your doctor may do further tests on the bone marrow sample. These are called cytogenetic tests.

Cytogenetics is the study of chromosomes. Chromosomes are made up of genes, and genes carry the instructions that cells need to work properly. Cytogenetic tests look for changes in the chromosomes of the myeloma cells. The aim is to learn more about the cells and how they might respond to treatment.

One type of test is called a FISH test (fluorescence in situ hybridisation test). When your doctor talks about the results of your FISH test or other cytogenetic tests, they may use the terms high-risk or low-risk.

There are different treatments for myeloma. A team of specialists meets to discuss and plan the best treatment for you. This is called a multidisciplinary team (MDT).

Your doctor and nurse will explain the different treatments and their side effects. They can also talk with you about what to think over before you make decisions about treatment.

The type of treatment your doctor offers depends on a number of things, including your general health.

If the myeloma isn't causing symptoms, you don't usually need treatment straight away. Myeloma with no symptoms is called smouldering or asymptomatic myeloma. You'll have regular check-ups and tests instead, and this is called active monitoring.

Once the myeloma begins to cause symptoms, you'll start treatment. Myeloma with symptoms is called active or symptomatic myeloma. If you have active myeloma, you may have intensive treatment or less intensive treatment.

Less intensive treatments include:

• targeted therapies
• chemotherapy
• steroids
• managing symptoms

Usually, a combination of these treatments is used.

Some people might have intensive treatment. This depends on how the myeloma is affecting you and on your general health. If your doctor thinks this treatment is suitable for you, they'll talk with you about it.

You will usually have regular follow-up appointments at the hospital while you're being treated and when you're in remission. Sometimes these check-ups are with your doctor instead. This is often called a shared care agreement (follow-up care).

If you have smouldering myeloma (myeloma without symptoms), you'll also have follow-up checks every few months.

If you have any problems, or notice any new symptoms between appointments, tell your doctor or specialist nurse as soon as possible.