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This entry was posted in Health Services and tagged Multiple Myeloma on January 9, 2015 by sunnyliz
Multiple Myeloma is a cancer of plasma cells in which abnormal plasma cells multiply uncontrollably in the bone marrow and occasionally in other parts of the body. Normally, plasma cells make up less than 1% of the cells in the bone marrow; in multiple myeloma, typically the vast majority of bone marrow elements are cancerous plasma cells. The overabundance of these cancerous plasma cells in the bone marrow leads to the increased production of protein that suppress the development of other normal bone marrow elements, including WBCs, RBCs, and platelets (cell-like particles that help the body form blood clots). In addition, the abnormal plasma cell almost always produce large amount of a single type of antibody accompanied by a markedly reduced amount of all other types of antibodies.
Often, collections of cancerous plasma cells develop into tumors that lead to loss of bone most commonly in the pelvic bones, spine, rib, and skull. Infrequently, these tumors develop in areas other than bone, particularly in the lungs, liver, and kidney.
Multiple Myeloma, the most common type of primary cancerous bone, tumor, originates in the bone marrow cells that produce blood. This tumor may affect one or more bones, so pain may occur in one location or in several. If only one bone is involved, the condition is called plasmacytoma; if more than one is bone is involved, the condition is called multiple myeloma.
Typically, multiple myeloma occurs in people at least 60 years of age. Although its cause is not certain, the increased occurrence of multiple myeloma among close relatives indicates that heredity plays a role. Exposure to radiation is thought to be a possible cause, as is exposure to benzene and other solvent. A herpesvirus, HHV-8, may play some role in the disease.
Age over 65: Growing older increases the chance of developing multiple myeloma. Most people with myeloma are diagnosed after age 65. This disease is rare in people younger than 35.
Race: The risk of multiple myeloma is highest among African Americans and lowest among Asian Americans. The reason for the difference between racial groups is not known.
Being a man: Each year in the United States, about 11,200 men and 8,700 women are diagnosed with multiple myeloma. It is not known why more men are diagnosed with the disease.
Personal history of monoclonal gammopathy of undetermined significance (MGUS): MGUS is a benign condition in which abnormal plasma cells make M proteins
Family history of multiple myeloma: Studies have found that a persons risk of multiple myeloma may be higher if a close relative had the disease.
Many other suspected risk factors are under study. Researchers have studied whether being exposed to certain chemicals or germs (especially viruses), having alterations in certain genes, eating certain foods, or being obese increases the risk of developing multiple myeloma. Researchers continue to study these and other possible risk factors.
Myeloma, like other cancers, begins in cells. In cancer, new cells form when the body doesnt need them, and old or damaged cells dont die when they should. These extra cells can form a mass of tissue called a growth or tumor.
Myeloma begins when a plasma cell becomes abnormal. The abnormal cell divides to make copies of itself. The new cells divide again and again, making more and more abnormal cells. These abnormal plasma cells are called myeloma cells.
In time, myeloma cells collect in the bone marrow. They may damage the solid part of the bone. When myeloma cells collect in several parts of the bones, the disease is called multiple myeloma. This disease may also harm other tissues and organs, such as the kidneys.
Myeloma cells make antibodies called M proteins and other proteins. These proteins can collect in the blood, urine, and organs.
In multiple myeloma, plasma cells produce an amount of specific immunoglobulin that is nonfunctional. Functional immunoglobulin are still produced by nonmalignant plasma cells, but in lower than normal quantity. The specific immunoglobulin secreted by the myeloma cell is detectable in the blood or urine and is referred to as monoclonal protein or M protein. This protein serve as a useful marker to monitor the extent of disease and patients responds to therapy. It is commonly measured by serum or urine protein electrophoresis. The patient’s total protein level is typically elevated because of production of M protein. Malignant plasma cells also secret certain substances to stimulate the creation of new blood vessels (i.e. angio-genesis) to enhance the growth of these cluster of plasma cell. Occasionally the plasma cells infiltrate other tissue, in which the case they are referred to as plasmacytomas. Plasmacytomas can occur in the spinal cord, sinuses and soft tissues.
The classic presentation is bone pain. It increases with movement and decreases with rest. Patients may report that they have less pain on awakening but more during the day. In myeloma a substance secreted by plasma cells, osteoclast activating factor and other substances (e.g. interleukin-6 [IL-6] are involved in stimulating osteoclasts. Both mechanisms appear to be in the process of bone breakdown. Thus lytic lesion as well as osteoporosis may be seen on bone x-rays but do not visualize on bone scans. The bone destruction can cause severely vertebral collapse and fractures, including spinal fracture, which can imping spinal cord and result in spinal cord compression.
If the bone destruction is fairly extensive, excessive ionized calcium is lost from the bone and enters the serum; hypercalcemia may develop resulting in excessive thirst, dehydration, constipation, altered mental status, confusion and perhaps coma. Renal failure may also occur; the configuration of the circulation immunoglobulin molecule can damage renal tubules.
A blood test called serum protein electrophoresis separates your blood proteins and can detect the presence of monoclonal proteins (M proteins) — referred to as an M spike — in your blood. Parts of M proteins may also be detected in a test of your urine. When M proteins are found in urine, theyre referred to as Bence Jones proteins. Monoclonal proteins may indicate multiple myeloma, but also can indicate other conditions.
Imaging. X-rays of your skeleton can show whether your bones have any thinned-out areas, common in multiple myeloma. If a closer view of your bones is necessary, your doctor may use magnetic resonance imaging (MRI), computerized tomography (CT) scanning or positron emission tomography (PET) scanning.
Bone marrow examination. Your doctor may also conduct a bone marrow examination by using a needle to remove a small sample of bone marrow tissue. The sample is then examined under a microscope to check for myeloma cells. A portion of the sample is also tested for chromosome abnormalities using tests such as fluorescence in situ hybridization (FISH). Tests are also done to measure the rate at which the plasma cells are dividing.
Multiple myeloma develop in different stages however, my patient is in stage 2 the tumors have start spreading to other parts of his body, affect kidney, pneumonia (coughing) , Anemia and hypocalcaemia (osteoporosis). Patients are expected to live up to 44 months at this stage.