What Is Myeloma, How Is It Diagnosed, Who Gets It, and Why?

This is the first part of our series about the condition based on our patient booklet “Fast Facts for Patients and their Supporters: Myeloma”, which is freely available online. This article focuses on:

What is myeloma?
How is myeloma diagnosed?
Who gets myeloma and why?

What Is Myeloma?

Myeloma is a cancer that affects a type of white blood cell called a plasma cell. Normally, the production of plasma cells in bone marrow is tightly controlled. In myeloma, this control is lost and large numbers of abnormal plasma cells, called myeloma cells, are produced instead.

The increase in the number of myeloma cells interferes with the production of other types of blood cell in your bone marrow. The myeloma cells divide in the bone marrow and release proteins that affect different parts of the body. For this reason, the disease is sometimes called multiple myeloma.

How Is Myeloma Diagnosed?

Myeloma is one of the most difficult cancers to detect. For many people, the first step towards diagnosis is a visit to their family doctor (GP) because of symptoms such as tiredness, pain or recurrent infections. These symptoms are not specific to myeloma, so myeloma may not be considered until the patient has seen a doctor several times. Others may be diagnosed after admission to hospital with more severe problems, such as fractures, kidney problems or spinal cord compression.

The diagnosis of myeloma is usually made by a specialist in blood disorders, a hematologist, who will look at the results of blood and urine tests, a bone marrow biopsy and X-rays.

Blood and urine tests measure how much abnormal protein (paraprotein) or light chains you have in your body, the level of calcium in your blood and the number of normal blood cells. They also show how well the kidneys are working.
A bone marrow biopsy will be taken if you have paraproteins in your blood or abnormally high levels of light chains in your blood or urine. A needle will be inserted into a prominent part of your pelvic bone (not your hip or spine) to extract a sample of bone marrow, which is then examined under a microscope to see if there are any abnormal cells. The biopsy is usually done under local anesthetic, and takes about 15–20 minutes. You may be offered a mild sedative to make you feel more comfortable while the biopsy is taken. You may feel bruised or ache for a few days afterwards, but mild painkillers should help with this. You may need further biopsies (for example, after treatment to confirm remission).
X-rays may be useful to look for signs of damage to the bones.

Depending on the results of these initial tests, your doctor may suggest further scans to show the presence and extent of myeloma in your body. You may be given an injection of dye before the scan starts, so that certain structures show up more clearly on the scan. You should let your doctor know if you are asthmatic or allergic to iodine, because these could cause a reaction to the dye. The scans will produce a detailed picture of certain areas, such as your spine or, occasionally, your whole body.

Magnetic resonance imaging (MRI) uses a powerful magnetic field to create a detailed image. You will need to lie motionless inside a cylindrical tube for about 30 minutes. It can be noisy inside the machine. Patients with bone damage can find it painful. Check with your doctor about the use of painkillers or anxiolytics (to reduce anxiety) before the procedure takes place.

Computed tomography (CT) involves taking a series of X-rays, which are combined by computer software to build up a 3D image of the inside of your body. This may take up to half an hour.

Who Gets Myeloma and Why?

Myeloma is a relatively rare cancer, accounting for only 1–2% of all cancers. The exact cause is not yet known, but is likely to be a combination of the following risk factors, which are unique to each individual.
Older age: more than 4 in 10 people with myeloma are over 75 years of age.
Family history: early data suggest that a close relative with myeloma (e.g. a parent, brother or sister) increases the risk slightly, but environmental risk factor(s) probably need to be present as well.
Exposure to radiation (X-rays, background, atomic), chemicals and viruses
MGUS (monoclonal gammopathy of undetermined significance): on average 1% of people with this condition develop myeloma in the course of a year, but all myeloma cases arise from MGUS
Race: almost 10 times more common in African / African Caribbean people than in white people. Less common in Asian people
Obesity
Male sex: slightly more common in men than women