Multiple Myeloma
Original Editors - Jill Jones from Bellarmine University's Pathophysiology of Complex Patient Problems project.
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Definition/Description[edit | edit source]
Multiple myeloma is a primary malignant neoplasm, or cancer, caused by uncontrolled growth of plasma cells in the bone marrow. The excessive growth of plasma cells that originate in the bone marrow destroys bone tissue and is associated with widespread osteolytic lesions (decreased areas of bone density) [1][2].
According to Goodman and Fuller, tumors of this type initially affect the bones and bone marrow of the vertebrae, ribs, skull, pelvis, and femur. These regions are most often affected because of their high concentrations of bone marrow. The progression of this disease can cause damage to the kidney, lead to recurrent infections, and often affects the nervous system [2]. To date, multiple myeloma is an incurable disease with a poor prognosis. Most individuals die within 1 to 3 years after the diagnosis is made [1].
FDG PET scan of a patient with multiple myeloma with severe diffuse and focal disease [3]
Prevalence[edit | edit source]
· Annual incidence of approximately 16,570 cases of the multiple myeloma in the United States
· 11,310 deaths from multiple myeloma in the United States in 2006
· Occurs less often than the most common cancers (e.g. breast, lung, or colon)
· Disease can develop at any age, but most commonly seen in persons between the ages of 50 and 70 years
o Median age of diagnosis is 69 years for men and 71 years for women
o Only 5% of clients with multiple myeloma are younger than 40 years old
· Multiple myeloma is more common in men and African Americans [1][2]
Characteristics/Clinical Presentation[edit | edit source]
Multiple Myeloma presence and pain [2]:
· Location: skeletal pain, especially in the spine, sternum, rib, leg, or arm
· Referral: according to the location of the tumor
· Description: sharp, knifelike
· Intensity: moderate to severe
· Duration: intermittent, progressing to constant
· Associated signs and symptoms:
o Hypercalcemia – dehydration (vomiting), polyuria, confusion, loss of appetite, constipation
o Bone destruction with spontaneous bone fracture
o Neurologic – Carpal tunnel syndrome; back pain with radicular symptoms; spinal cord compression (motor or sensory loss, bowel/bladder dysfunction, paraplegia)
When to see a doctor, according to Mayoclinic.com:
If you're persistently more tired than you used to be, you've lost weight, and you experience bone pain, repeated infections, loss of appetite, excessive thirst and urination, persistent nausea, increased constipation, or weakness or numbness in your legs, your signs and symptoms may indicate multiple myeloma or other serious disease. See your doctor to determine the underlying cause [4].
Associated Co-morbidities[edit | edit source]
Excerpt from the International Myeloma Foundation website [5]:
TABLE 2: MEDICAL PROBLEMS RELATED TO MYELOMA
Image:TABLE_2_MEDICAL_PROBLEMS_RELATED_TO_MYELOMA.jpg
Medications[edit | edit source]
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Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]
Blood tests can help diagnose this disease. They may include [6]:
- Blood chemistry (CHEM 20) may show increased levels of
calcium, total protein, and abnormal kidney function
- Complete blood count (CBC) reveals low numbers of red
and white blood cells and platelets
- Serum protein electropheresis (SPEP)
- Urine protein electrophoresis (UPEP) or Bence-Jones
protein analysis
- Quantitative immunoglobulins (nephelometry)
This bone marrow tissue sample shows myeloma cells (bluish-stained cells). These cells crowd out normal bone marrow cells[4]
Bone x-rays show fractures or hollowed out areas
of bone. If your doctor suspects this type of cancer, a bone marrow biopsy will
be performed.
Major and minor criteria were created to distinguish multiple myeloma from asymptomatic myeloma and monoclonal gammopathies of undetermined significance (MGUS). Clients must have at least one major and one minor or three minor criteria to be diagnosed with multiple myeloma.
Criteria for the Diagnosis of Multiple Myeloma [1]:
Image:Multiple_myeloma_diagnostic_criteria.jpg
Causes[edit | edit source]
The exact cause of multiple myeloma is unknown. It has been reported that the beginning of multiple myeloma begins with the presence and multiplication of an abnormal plasma cell in the bone marrow. Exposure to ionizing radiation and occupational hazards (i.e. petroleum, leather, lumber, and agricultural industries) may be linked to the presence of this abnormal plasma cell formation. Abnormal cells do not behave as normal cells do, with maturation and death. These abnormal cells accumulate and thus eventually overwhelm the number and production of healthy cells. Statistically, in healthy bone marrow less than 5 percent of the cells are plasma cells. Individuals with multiple myeloma display a presence of more than 10 percent of the cells in bone marrow being plasma cells. Multiple myeloma is a malignancy that increases the rate of abnormal cell division. Uncontrolled plasma cell growth can damage bones and surrounding tissue. It can also interfere with your immune system's ability to fight infections by inhibiting your body's production of normal antibodies [1][4].
Systemic Involvement[edit | edit source]
Multiple myeloma systemic involvement list excerpt from Goodman and Snyder 3:<o:p></o:p>
· Immune system: <o:p></o:p>
o Recurrent bacterial infections (especially pneumococcal pneumonias)<o:p></o:p>
· Circulatory system: <o:p></o:p>
o Anemia with weakness and fatigue<o:p></o:p>
o Bleeding tendencies<o:p></o:p>
· Skeletela system:<o:p></o:p>
o Bone destruction<o:p></o:p>
§ Skeletal/bone pain (especially pelvis, spine and ribs)<o:p></o:p>
§ Spontaneous fracture<o:p></o:p>
§ Osteoporosis<o:p></o:p>
§ Hypercalcemia (confusion, increased urination, loss of appetite, abdominal pain, vomiting, and constipation)<o:p></o:p>
· Urinary system:<o:p></o:p>
o Renal involvement<o:p></o:p>
§ Kidney stones<o:p></o:p>
§ Renal insufficiency<o:p></o:p>
· Neurological systems:<o:p></o:p>
o Neurologic abnormalities<o:p></o:p>
§ Carpal tunnel syndrome<o:p></o:p>
§ Back pain with radicular symptoms<o:p></o:p>
§ Spinal cord compression (motor or sensory loss, bowel/bladder dysfunction, paraplegia)<o:p></o:p>
Medical Management (current best evidence)[edit | edit source]
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Physical Therapy Management (current best evidence)[edit | edit source]
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Alternative/Holistic Management (current best evidence)[edit | edit source]
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Differential Diagnosis[edit | edit source]
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Case Reports[edit | edit source]
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Resources
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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- ↑ 1.0 1.1 1.2 1.3 1.4 Goodman C, Fuller K. Pathology: Implications for the Physical Therapist. St. Louis: Saunders Elsevier; 2009.
- ↑ 2.0 2.1 2.2 2.3 Goodman C, Snyder T. Differential Diagnosis for Physical Therapists: Screening for Referral. St. Louis: Saunders Elsevier; 2007.
- ↑ 6. University of Arkansas for Medical Sciences website. 2010. Available at: http://www.uams.edu/radiology/info/clinical/pet/images.asp. Accessed March 1, 2010.
- ↑ 4.0 4.1 4.2 Mayoclinic.com. 2010. Available at: http://www.mayoclinic.com/health/multiple-myeloma/DS00415. Accessed March 1, 2010.
- ↑ 4. International Myeloma Foundation website. 2010. Available at: http://myeloma.org/ArticlePage.action?tabId=1&menuId=161&articleId=2732&aTab=-1&gParentType=menuitem&gParentId=161&parentIndexPageId=52&parentCategoryId=443. Accessed March 3, 2010.
- ↑ 1. A.D.A.M. Google Health: Multiple Myeloma. 2010. Available at: https://health.google.com/health/ref/Multiple+myeloma. Accessed March 1, 2010.
