Multiple Myeloma: Frequently Asked Questions

Here are some answers to frequently asked questions about multiple myeloma.

What is multiple myeloma?

Multiple myeloma is a kind of cancer that starts in plasma cells. This is a type of white blood cell. These cells make proteins called antibodies (immunoglobulins). They help your body fight infection. When plasma cells grow out of control, they build up either in the bone marrow or in organs. The tumors that are formed can destroy normal bone tissue. This can cause bone pain and sometimes breaks (fractures). The tumors can also cause large amounts of calcium to leave the bones and enter the blood. This can cause problems. These include confusion, pain, and kidney failure. 

Cancerous plasma cells can also crowd the bone marrow. This can keep healthy cells from working normally. That means people with multiple myeloma may not make enough white and red blood cells. They may also have fewer platelets. These are needed for blood to clot. Plus, since plasma cells help the body fight disease, if a group of them is cancerous, the body is not as able to fight infection. People with multiple myeloma are at greater risk of getting infections.

Cancerous plasma cells can also make large numbers of antibodies. These can travel through the blood and damage organs, such as the kidneys.  

Who gets multiple myeloma?

Most people who get multiple myeloma are 65 or older. It’s rarely seen in people younger than age 35. More men get it than women get it. So do more African-American people than white people. Multiple myeloma is an uncommon cancer. Experts aren’t sure why one person gets it and another one does not.

What are the risk factors for multiple myeloma?

Certain factors can make 1 person more likely to get multiple myeloma than another person. These are called risk factors. Some risk factors have been identified, but these only slightly raise a person’s risk of getting the disease. Healthcare providers have found some risk factors for multiple myeloma. But they aren’t sure how much a part these play in someone getting the disease. Risk factors for this cancer include:

• Older age. Less than 1% of cases are diagnosed in people younger than age 35.

• Gender. Men are slightly more likely to get multiple myeloma.

• Race. African-Americans are more likely to have this cancer.

• Exposure to radiation. This accounts for a small number of cases.

• Family history. Having a sibling or parent who has it may raise your risk.

• Exposure to chemicals. Your risk may be higher if you work with certain substances. These include benzene or some pesticides.

• Certain health issues. Being overweight or obese may increase your risk.  

• Certain plasma cell diseases. These include solitary plasmacytoma and monoclonal gammopathy of undetermined significance (MGUS). These issues are considered "precursors" to myeloma. They may or may not become multiple myeloma.  

What are the symptoms of multiple myeloma?

A person’s symptoms depend on how advanced the cancer is. Some people with early multiple myeloma have no symptoms. Instead, it may be found during routine blood or urine tests. People may feel pain in their bones, often in their back or ribs. Some people may get broken bones since the cancer causes the bones to weaken. Other people feel tired and weak. They may have more infections than normal, and they may lose weight or have other problems. Some people feel thirsty all the time and have to urinate often. These symptoms do not mean that a person has multiple myeloma. Other things could be causing these symptoms. If you have these symptoms, see your healthcare provider.

How is multiple myeloma diagnosed?

Your healthcare provider will ask questions about your symptoms and health and family history. He or she will also ask about your history of exposures. Your healthcare provider will do a physical exam to check for signs of the cancer. He or she may order these tests to help make the diagnosis:

• Blood tests

• Urine tests

• X-rays

• CT scan

• MRI

• Positron emission tomography (PET scan)

• Biopsy, if the tumor is in soft tissue

• Bone marrow aspiration and biopsy

Should everyone get a second opinion for multiple myeloma?

Many people with cancer get a second opinion from another healthcare provider. There are many reasons to get one. Here are some of those reasons:

• Not feeling comfortable with the treatment decision

• Being diagnosed with a rare type of cancer

• Having several options for how to treat the cancer

• Not being able to see a cancer expert

Many people have a hard time deciding which treatment to have. It may help to have a second healthcare provider look at the diagnosis and treatment options before starting treatment. Note that, in most cases, a short delay in treatment will not lower the chance that it will work. Some health insurance companies even require that a person with cancer seek a second opinion. Many insurance companies will pay for a second opinion.  

How can I get a second opinion for multiple myeloma?

There are many ways to get a second opinion.

• Ask a primary care healthcare provider. He or she may be able to suggest a specialist. This may be a hematologist, medical oncologist, or radiation oncologist. Sometimes these doctors work together at cancer centers or hospitals. Never be afraid to ask for a second opinion.

• Call the National Cancer Institute’s Cancer Information Service. The number is 800-4-CANCER (800-422-6237). They have information about treatment facilities. These include cancer centers and other programs supported by the National Cancer Institute.

• Seek other options. Check with a local medical society or a support group to get the names of providers who can give you a second opinion. You can also ask a nearby hospital or medical school. Or ask other people who’ve had cancer for their suggestions.

How is multiple myeloma treated?

Some people with early (often called "smoldering") multiple myeloma may not need treatment right away. In this case, your healthcare provider will closely watch you. If you have certain symptoms or your disease is progressing, you will start treatment.

Treatment for multiple myeloma is mainly systemic. These kinds of treatments kill or control cancer cells all through your body. Healthcare providers almost always use chemotherapy, targeted therapy, or other medicines to treat people with multiple myeloma. They may also use stem cell transplants. Although these treatments won’t cure the myeloma, they can often help people live for many years.

Local treatments fight cancer cells in one area. Radiation is an example. Healthcare providers use it to control bone pain or prevent breaks.

What’s new in multiple myeloma research?

Cancer research should give you hope. Experts around the world are learning more about what causes multiple myeloma. They are looking for and studying ways to prevent it. They are also finding better ways to detect and treat this cancer.

Studies are being done to improve survival in people with multiple myeloma who are treated with high-dose chemotherapy and stem cell transplants.

Researchers have found that cells in the bone marrow (stromal cells) promote the growth of multiple myeloma. Medicines such as thalidomide and lenalidomide can prevent this and kill myeloma cells. These medicines are now often part of the treatment for this cancer. Many other new types of medicines are being studied as well.  

What should I know about clinical trials for multiple myeloma?

Clinical trials are studies of new kinds of cancer treatments. Healthcare providers use clinical trials to learn how well new treatments work and what their side effects are. Promising treatments are ones that work better or have fewer side effects than the current treatments. People who participate in these studies get to use treatments before the U.S. Food and Drug Administration (FDA) approves them. People who join trials also help researchers learn more about cancer and help future people with cancer.