Cancer: Combat and cure

Multiple myeloma is a cancer formed by malignant plasma cells. Dr Murali Subramanian explains the disease and treatment options

Did you know that one of the lesser-known causes of cancer is an increase in life expectancy?

This means that the more we work towards increasing life expectancy, the chances of having cancer increase. This can be attributed to urbanisation, industrialisation, lifestyle changes and population growth. In India, it is estimated that life expectancy of the Indian population will increase to 70 years by 2021–25.

Most people are not aware of the different kinds of cancers they can be affected with, especially with symptoms as common as a backache, skin allergy and anaemia, among others.

Cancer can begin in any remote corner of the body where cells start growing uncontrollably.

There are many kinds of cancer, but they all are triggered by the abnormal growth of cells. A patient suffering from multiple myeloma has symptoms which are very common like backache (as it first affects the bones), anaemia and kidney-related problems. These symptoms are common ailments among men aged 65 years and above, who are most likely to ignore these issues.

Bone problems

Multiple myeloma is a cancer formed by malignant plasma cells. Normal plasma cells, which are found in the bone marrow, are an important part of the immune system. Here, plasma cells become cancerous and grow out of control; they can produce a tumour called plasmacytoma.

These tumours generally develop in a bone, but they are also found in other tissues. Any bone can be affected, but pain in the back, hips, and ribs are particularly common with this disease. These changes also increase the chance of bone fracture. Myeloma cells can also interfere with cells that help keep the bones strong. Myeloma cells create a substance that speeds up the dissolving of the bone. This makes the bones brittle.

Low blood count

The overgrowth of plasma cells in the bone marrow can crowd out the normal blood-forming cells, thus, leading to low blood count. This causes anaemia (low hemoglobin) — a shortage of red blood cells. Anaemia can lead to fatigue and weakness. Multiple myeloma can trigger weakness, reduced ability to exercise, shortness of breath and dizziness.

Kidney problems

Myeloma protein can damage the kidneys too. This does not reveal symptoms early on, but can be detected with a blood test. As the kidneys starts to fail, they lose the ability to dispose of excess salt, fluid, and body waste. This can lead to symptoms like weakness and swelling in the leg. This eventually leads to kidney damage and kidney failure, some times even requiring dialysis.

Tests for detecting multiple myeloma are blood tests (in particular Protein Electrophoresis ) X-rays, bone-marrow and biopsy, among other tests. 

Bone-marrow biopsy

Those with multiple myeloma have too many plasma cells in their bone-marrow. The procedure to check the bone-marrow is called a bone-marrow aspiration. It can be either done at the doctor’s office or at a hospital.

Bone X-rays

Bone destruction caused by myeloma cells can be detected with an X-ray. Doctors will perform a series of X-ray scans that include most of the bones. This is called a bone survey or a skeletal survey.

Blood tests

Complete Blood Count (CBC) is a test that measures the level of red cells, white cells, and platelets in the blood.  If myeloma cells occupy too much of the bone marrow, levels of these blood cells will be low. This test can be done in any hospital. A specific blood test which detects the abnormal accumulation of immunoglobulins (protein electrophoresis) is usually ordered.

A few of the major and initial treatments are chemotherapy, surgery and stem-cell transplant, among other treatments.

Chemotherapy and other drugs

Chemotherapy (chemo) is the use of drugs to destroy or control cancer cells. These drugs can be swallowed or injected into a vein. They enter the bloodstream and reach all areas of the body, making this treatment useful for cancers such as multiple myeloma that often spread widely.

Radiation therapy

Radiation therapy uses focused high-energy X-rays or particles that penetrate the tissues of the body to reach and destroy cancerous cells. Radiation may be used to treat areas of bone damaged by myeloma that have not responded to chemotherapy and are causing pain. It is also the most common treatment for solitary plasmacytomas.

Stem cell transplant

This has become the standard treatment for younger myeloma patients, in otherwise good health. Several studies have shown that this treatment increases the rate of survival compared to standard chemotherapy. The first step is to reduce the amount of cancer in a patient’s body. Many different drug combinations can be used.

Surgery

Although surgery is sometimes used to remove single plasmacytomas, it is rarely used in treating multiple myeloma. When spinal cord compression causes paralysis, severe muscle weakness, or numbness, emergency surgery may be needed. Non-emergency (elective) surgery to attach metal rods or plates can help support weakened/fractured bones.

(The author is Consultant Medical Oncologist, M S Ramaiah Curie Center of Oncology)