Signs and Symptoms of Multiple Myeloma

Spotting the Early Signs of This Deadly Blood Cancer

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Multiple myeloma is a cancer of the plasma cells in the bone marrow. Plasma cells are an important part of the immune system. When these cells become malignant, they produce a tumor, usually in the bone but also in other parts of the body.

The early symptoms of multiple myeloma can go unnoticed because they are often vague and non-specific. The disease can also mimic other, less serious conditions and only become evident after a routine blood exam.

Knowing the signs of multiple myeloma is the best way to get diagnosed and treated early when success rates are highest.

Early Signs of Multiple Myeloma

The most common symptoms of multiple myeloma are bone pain and fracture. Other symptoms are related to complications of the disease as it begins to, directly and indirectly, impact other organ systems, including the kidneys, brain, and gastrointestinal tract.

Early, nonspecific symptoms can include:

  • fatigue
  • increased or decreased urination
  • restlessness followed by exhaustion
  • nausea and vomiting
  • unexplained weight loss
  • increased vulnerability to infections

Any of these symptoms would reasonably warrant a doctor’s visit, especially if they are unexplained, persistent, or worsening. Unexplained weight loss, in particular, is a common feature of all cancers, including multiple myeloma.

Bone-Related Symptoms of Multiple Myeloma

Bone pain is one of the first tell-tale signs of multiple myeloma.

Low back pain is common, although pain can occur around the ribs, hips, and even the skull. While bone pain can be caused by other non-malignant conditions, the symptom should always be of concern to younger persons in whom bone problems are less common.

An unexplained bone fracture is usually the event that leads doctors to explore multiple myeloma as a possible cause.

The spine, ribs, and pelvis are where most fractures occur as a result of the degenerative bone loss (osteoporosis) seen in people with multiple myeloma.

Elevated Calcium as a Symptom of Multiple Myeloma

Elevated levels of calcium in the blood, known as hypercalcemia, is also a sign of multiple myeloma. As myeloma cells break down bone matter, calcium is released into the bloodstream, causing the accumulation.

Symptoms of hypercalcemia include:

  • nausea
  • loss of appetite
  • fatigue and weakness
  • excessive thirst or urination
  • constipation
  • confusion
  • kidney failure

Anemia in Multiple Myeloma

As myeloma cells begin to proliferate in the bone marrow, normal cells are progressively squeezed out. This results in the depletion of red blood cells, called hemoglobin, resulting in a condition called anemia.

While a person can become anemic for any number of reasons, accompanying drops in white blood cells and platelets will usually lead doctors to more aggressive investigations.

Symptoms of anemia include:

  • paleness
  • dizziness
  • weakness and fatigue
  • shortness of breath
  • heart palpitations

A depletion of white blood cells can increase a person’s risk of infections, including pneumonia and urinary tract infections. A decreased number of platelets can predispose a person to easy bleeding.

Kidney Disorders as Symptoms of Multiple Myeloma

High levels of calcium and myeloma protein can damage the kidneys as they are filtered from the blood and accumulate within the vascular network of the kidneys. When this happens, the kidneys lose their ability to regulate body waste, fluids, and blood pressure and eventually fail.

Common signs of kidney failure include:

  • swelling of the legs and ankles
  • weakness
  • reduced urination
  • shortness of breath
  • persistent nausea
  • pain or pressure in the chest

While kidney failure usually happens in people with advanced multiple myeloma, it has also been known to occur during the early stages of the disease.

Hyperviscosity as a Symptom of Multiple Myeloma

Thickened blood, also known as hyperviscosity, is caused by the excessive accumulation of proteins produced by cancerous plasma cells. When this happens, the blood is resistant to flow, resulting in a number of telltale symptoms:

  • nose bleeds
  • blurred vision
  • numbing or tingling in the arms or legs
  • heart failure

Numbness and Tingling as a Symptom of Multiple Myeloma

When the bones of the spine are weakened or fracture, they can collapse onto nerve roots and compress them. This can lead to a condition called radiculopathy. Symptoms include numbness, tingling, and weakness along the entire course of the nerve.

If the spinal cord is involved, a condition called spinal cord compression can result in severe back pain, loss of bladder or bowel control, sensory disturbances, and leg weakness. It is considered a medical emergency and a clear sign of a major disorder involving the skeletal and nervous systems.

A Word From Verywell

The standards for diagnosing multiple myeloma are complicated with no single lab test able to definitively diagnose the disease. Therefore, spotting the early signs of cancer — whether it be unusual blood test readings, changes in health, or unexplained pain or weight loss — becomes all the more important in determining how soon you can be diagnosed and treated.

When it comes early diagnosis, the following rules apply:

  • Never ignore a persistent condition or consider it the "new normal" as you get older.
  • Go to your doctor if you are experiencing any symptom that you can’t explain or just won’t go away.
  • At the very least, schedule an annual physical with the full range of blood tests to spot any changes that might be worrisome.

Sources

  • American Cancer Society. “What Is Multiple Myeloma?” Washington, D.C.; last reviewed January 2016.
  •  Rajkumar, S.; Dimopoulos, M.; Palumbo, A.; et al. “International myeloma working group updated criteria for the diagnosis of multiple myeloma.” Lancet Oncol. 2014; 15(12):e538-48.

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