Chủ Nhật, 13 tháng 10, 2013

Multiple Myeloma – Symptoms, Prognosis, Causes, Stages, Treatment

Multiple Myeloma – Symptoms, Prognosis, Causes, Stages, Treatment

What is Multiple Myeloma?

This is a form of cancer of the plasma cells – which are a kind of white blood cells which are present in bone marrow. These cells usually create proteins known as antibodies which help an individual fight any infection.

With multiple myeloma, the group of atypical plasma cells – myeloma cells – reproduces, increasing the plasma cell numbers to a much higher level than is normal. Because these cells usually create proteins, the amount of atypical proteins within your blood also can go up. Because of this, health problems which are caused by multiple myeloma will affect your immune system, bones, red blood cell count as well as kidneys.

Multiple Myeloma Symptoms

The symptoms and signs of multiple myeloma usually differ from individual to individual. While the illness often may not cause symptoms initially in the beginning stages of the disease, it is likely that you will experience several of the below listed symptoms as this illness progresses:

  • Pain in the bone, especially in the skull, ribs, pelvis as well as the back.

  • Presence of proteins which are abnormal – that are produced by myeloma cells – in the urine or blood. These specific proteins – which are antibodies or portions of antibodies – are referred to as monoclonal or M, proteins.

  • These proteins are usually revealed during a normal yearly physical exam, and may designate multiple myeloma but can also indicate other disorders.

  • Calcium in high levels in the blood. This occurs when calcium from bones which are affected, dissolves into the blood. This high level of calcium in the blood can cause some of the following:

  • Excessive urination as well as thirst

  • Constipation

  • Loss of appetite

  • Nausea

  • Confusion mentally

  • Additional symptoms and signs of multiple myeloma can consist of:

    • Fatigue related to anemia as the myeloma cells start to replace red blood cells in the bone which carry oxygen.

    • Bone fractures which are unexplained

    • Recurrent infections – for example sinusitis, pneumonia, kidney or bladder infections, shingles as well as skin infections

    • Weakness as well as numbness in the legs

    • Weight loss

    Multiple Myeloma Causes

    The exact cause of this disease is not known, but medical professionals do understand that multiple myeloma starts with only one plasma cell which is abnormal in the bone marrow. Bone marrow is the blood producing, soft tissue that fills the center of most human bones. This one cell which is abnormal then begins to multiply.

    Since these abnormal cells do not mature and die as any normal cells should, they accumulate and ultimately overcome the creation of normal, healthy cells. In bone marrow which is healthy, fewer than 5% of the cells are plasma cells. But in those individuals with multiple myeloma, more than 10% of the cells can be plasma cells.

    Since myeloma cells can circulate in low numbers thru the blood system, they can ultimately populate bone marrow in other areas of the body – even far from the initiation point. This is why the name of the disease is multiple myeloma. Plasma cell evolution which is not controlled will damage bones as well as the adjoining tissue. It also can interfere with the immune system’s ability to combat infections by obstructing the body’s creation of normal antibodies.

    Multiple myeloma is not contagious. And most individuals who develop multiple myeloma have no identifiable risk factors for the disease. But there are some factors that might increase the risk of multiple myeloma and they include:

    Most individuals who develop this type of cancer are older than 50, with most being diagnosed in their middle 60s. There are very few cases in individuals 40 are younger.

    Males are most likely to develop this illness than females.

    Blacks are approximately 2X as likely to develop this disease as whites.

    History of MGUS
    Every year 1% of individuals who have MGUS in the US develop multiple myeloma.

    The risk of multiple myeloma increases if you are obese or overweight

    Other features which can raise the risk of developing multiple myeloma can include exposure to radiation as well as working in petroleum-related industries.

    Multiple myeloma can cause several complications:

    Impaired immunity
    Myeloma cells interfere with the production of antibodies which are needed for normal immunity. An individual with multiple myeloma is more likely to develop infections such as sinusitis, pneumonia, kidney or bladder infections, shingles as well as skin infections.

    Problems with bone
    Multiple myeloma affects bones, leading to the erosion of bone mass as well as frequent fractures. It can also cause compression of the spinal cord.

    Impaired function of the kidneys
    Multiple myeloma can cause problems with kidney function, including kidney failure. Calcium levels which are high in the blood related to eroding bones can interfere with the kidneys’ ability to filter blood waste.

    As the cancerous cells crowd out normal blood cells, multiple myeloma may also cause anemia and other problems with the blood.

    Treatment and Drugs

    An individual’s primary care physician can identify signs of multiple myeloma before the individual even has symptoms – thru urine as well as blood tests performed during routine yearly complete physical exam. When the individual does not have symptoms, these tests can be repetitive every few months so that doctors can track if the disease is progressing and decide the appropriate time which is best to begin treatment.

    A blood test called “serum protein electrophoresis” splits up the blood proteins and can identify any incidence of M proteins, known as an “M spike”, in the blood. As well parts of M proteins may also be identified in a test of urine but when established and found in urine; they are denoted as “Bence Jones” proteins.
    Other tests which may also be order by the physician include: detect diseases at an early stage symptoms, and find out the causes and treatments best suited.

    X-rays of the skeleton system can display whether the bones have any thinned-out areas, which is common in multiple myeloma. The physician may use computerized tomography or CT scanning, magnetic resonance imaging or MRI, as well as positron emission tomography or PET scanning.

    Bone marrow exam
    The physician may also conduct a bone marrow exam by using a needle to confiscate a small sample of bone marrow tissue. The section is then inspected under a microscope to look for myeloma cells.

    Standard treatment for Myeloma

    There is no known cure for multiple myeloma – but with good results from treatment an individual can normally go back to almost normal activity. There are also official clinical trials on new drug protocols that an individual may wish to ponder as another choice for treatment.

    Standard treatment possibilities include:

    This is the 1st drug approved in a fresh and different classification of drugs called “proteasome inhibitors”. This is administered by IV. It kills cancer cells by stalling the actions of proteasomes.

    The drug was initially used as a tranquilizer as well as to treat morning sickness back in the 1950s and was taken off of the marketplace after it caused terrible birth defects. But in 1998, the FDA approved thalidomide for the management of newly diagnosed individuals with multiple myeloma and is given orally.

    This is designed comparable to thalidomide but it seems to be more powerful and causes fewer side effects, it is normally used more often. It is given orally.

    This involves using drugs – both orally or given thru IV – to kill cancer cells. Most chemotherapy is given in phases over a time period of several months, trailed by a period of rest. If the M protein number remains steady chemotherapy is stopped but may need to be started again if the M protein begins to rise. Common chemotherapy drugs used to treat myeloma are Cytoxan, Alkeran, Oncovin, Adriamycin and Doxil.

    Normally dexamethasone and prednisone (Decadron) have been used for many years to treat multiple myeloma. Normally given as pills.

    Stem cell transplantation
    Treatment option which involves the use of high-dose chemotherapy – usually high dose melphalan – as well as transfusions of formerly gathered immature blood cells referred to as stem cells, to exchange for diseased or impaired marrow.

    Radiation therapy
    This therapy uses high-energy piercing waves to destroy myeloma cells and stop them from growing.

    Since multiple myeloma also causes numerous complications, you need to also have some treatment for definite conditions. For example:

    Back pain
    Pain drugs as well as wearing a back brace can comfort back pain.

    Kidney complications
    Individuals with extreme kidney damage will need dialysis

    Antibiotics is used to help treat infections

    Bone loss
    Drugs called bisphosphonates such as Aredia or Zomet can be taken to help to stop or at less reduce bone loss. Management with these drugs is often linked to harm of the jawbone.

    With persistent anemia, the individual may need erythropoietin injections. This is a obviously occurring hormone made in the kidneys that motivates the production of red blood cells.

    Multiple Myeloma Staging

    There are tests to help your doctor to classify the stages of this disease. These stages are classified as stage 1, stage 2 or stage 3. People with stage 3 myeloma are much more likely to have one or more signs of advancement of this disease, including greater numbers of myeloma cells as well as kidney failure.

    Multiple Myeloma Prognosis

    A prognosis for any type of cancer diagnosis is a medical opinion as to the likely course as well as outcome of the disease.

    Many factors will affect an individual patient’s cancer prognosis, including:

    • The location and type of the cancer

    • The stage of the disease – extent to which the cancer has metastasized or spread

    • Its grade – how abnormal the cancer cells look and how fast it is likely to grow and spread

    • The person’s general health, age and response to treatment

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