Cancer is a leading cause of death worldwide and it begins when the cells in our body grow out of control. Cells are present in nearly any part of the body that can cause cancer to easily spread to other areas. 

The type of cancer that forms in a particular type of white blood cell known as plasma cell causes Multiple Myeloma in human beings. 

In a typical healthy body, the plasma cells fight infections by making antibodies that recognize and attack germs. Normal plasma cells are found in the bone marrow and are an important part of the immune system.

When the plasma cells become cancerous and grow out of control, it leads to multiple myeloma. In multiple myeloma, rather than producing helpful antibodies, cancerous plasma cells get accumulated in the bone marrow and crowd out healthy blood cells which can cause complications. 

The plasma cells make an abnormal protein (antibody) known by several different names, including monoclonal immunoglobulin, monoclonal protein (M-protein), M-spike, or paraprotein.

Multiple myeloma results in these conditions:

• Low blood counts

The overgrowth of plasma cells in the bone marrow, crowds out normal blood-forming cells, leading to low blood counts. This leads to anaemia, making the person weak and fatigued.

The level of platelets in the blood also becomes low (called thrombocytopenia) due to multiple myeloma, leading to increased bleeding and bruising.

Yet another condition that can also develop is leukopenia (decreased white blood cells), which can cause hindrance in the body’s function to fight infections.

• Bone and calcium problems

Myeloma cells interfere with cells that help keep bones strong. With myeloma old bone is broken down without new bone to replace it, making the bones weak and easy to break. 

Fractured bones are a major problem in people with myeloma which in turn can also raise calcium levels in the blood. 

• Hyperviscosity problem

Hyperviscosity syndrome occurs when your blood thickens so much that it doesn’t flow freely through your blood vessels. Hyperviscosity syndrome is a serious condition. Without treatment, it can lead to artery blockages and reduced blood flow to your vital organs. In children, reduced blood flow can affect growth and development.

• Infections

The body doesn’t get protected from infections when there is the presence of abnormal plasma cells causing a hindrance in producing antibodies that are needed to fight the infections that can occur in a body.  

• Kidney problems

Myeloma cells produce an antibody that can harm the kidneys, leading to kidney damage and kidney failure as well.

Treatment for multiple myeloma isn't always necessary right away. If the multiple myeloma is slowly growing and isn't causing signs and symptoms, your doctor may recommend close monitoring instead of immediate treatment. Several options are available to help control the disease for people with multiple myeloma who require treatment.

Symptoms of Multiple Myeloma

The signs and symptoms of multiple myeloma can vary and early in the disease, there may be none.

When signs and symptoms do occur, they 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

• Excessive thirst

Diagnosis

There are a couple of tests used for diagnosing multiple myeloma. The major tests are mentioned below:

Blood and urine tests

The following blood and urine tests play a key role in diagnosing myeloma.

• Protein electrophoresis 

Protein electrophoresis measures certain proteins in the blood. The M protein levels in a patient's blood and urine can determine the extent of the disease and helps to monitor how well treatment is working and whether the disease is progressing or coming back. 

• Immunofixation Electrophoresis

The immunofixation blood test focuses on the presence of proteins in your blood. There are two primary types of proteins in your blood: albumin and globulin. The test divides these proteins into subgroups according to their electrical charge and size. This process is known as electrophoresis. This helps to examine the proteins in each subgroup and diagnose several diseases, especially multiple myeloma.

• Immunoglobulin

Immunoglobulin levels check the amount of antibody levels in the blood. These antibodies are immunoglobulin G (IgG), immunoglobulin A (IgA), and immunoglobulin M (IgM). With multiple myeloma, the cancer protein level goes up and the normal antibody levels are down.

• Kappa Lambda Light chain assay

This test is called serum-free light chain assay. This is a more sensitive test than measuring M protein in the urine, but both are important to measure. 

• Beta 2 microglobulin (β2-M)

(β2-M)  is a type of tumour marker. This test measures the amount of a protein called beta-2 microglobulin (β2-M) in the blood, urine, or cerebrospinal fluid (CSF). Healthy people have only small amounts of β2-M in their blood and urine.

• Lactase dehydrogenase (LDH)

Damaged tissues release LDH into the bloodstream, so LDH is used as a sign that the body has been injured or disease is present. In myeloma, LDH levels can be used to help determine prognosis, which is the chance of recovery, and the stage

These test results determine the stage of the myeloma. Blood tests are also used to measure kidney function, calcium levels, and blood cell counts for possible anaemia and other low blood counts.

Other Screening Methods include

• X-ray
• Magnetic resonance imaging (MRI)
• Computed tomography (CT or CAT) scan 
• Positron emission tomography (PET) or PET-CT scan
• Bone marrow aspiration and biopsy
• Fat pad aspirate
• Biomarker testing of the tumour
• Cytogenetics
• Fluorescence in situ hybridization (FISH)
• Minimal residual disease (MRD) tests

After diagnostic tests are done, your doctor will review the results with you. If the diagnosis is myeloma, these results also help the doctor describe cancer. This is called staging. 

To Summarise

If you're experiencing symptoms or know someone who has been experiencing it, treatment can help relieve pain, control complications of the disease, stabilize the condition, and slow the progress of multiple myeloma. 

Consultation and diagnosis is the key to treating and management of multiple myeloma.