In the early stages of myeloma, some patients have no signs or symptoms of disease. In about a fifth of myeloma patients, the cancer is detected before symptoms appear, often when results of laboratory tests that were part of a routine medical examination show changes in blood and/or urine. Some symptoms of myeloma include:
Bone pain and/or skeletal fractures. Bone pain is the most common early symptom of myeloma. Most patients feel pain in their back or ribs, but it can occur in any bone. The pain is usually constant and made worse by movement. Normally, bone is remodeled, or broken down and replaced, continuously in the body to keep it strong. This remodeling is a coordinated effect of cells that dissolve bone (osteoclasts) and cells that help build new bone (osteoblasts). Myeloma cells secrete a type of chemical called a “cytokine,” which stimulates the cells that dissolve bone (osteoclasts) and inhibits cells that form bone (osteoblasts). In other words, the osteoclasts work overtime, and the osteoblasts can't keep up, upsetting the cells' balance. This leads to holes in the bones, called lytic spots, and osteoporosis (low bone density). Bones can become frail enough to break or fracture in a minor fall or injury and even during normal activities, such as walking, lifting, sneezing or coughing. If not treated, the thin bones can cause long-lasting bone pain.
Fatigue and weakness as a result of low red blood cell counts (anemia). Myeloma patients may fatigue more easily and feel weak. They may have a pale complexion from anemia (the result of low hemoglobin concentration and/or a low red blood cell count). Anemia is a common medical problem for patients with myeloma, and may contribute to the fatigue.
Frequent infections due to a weakened immune system. Myeloma patients may experience repeated infections because the antibodies they need to fight invading viruses, bacteria or other disease agents are not made efficiently or in adequate numbers. A urinary tract, bronchial, lung, skin or other type of infection may be the first sign of the disease. In addition, recurrent infections may complicate the course of the disease.
Other signs and symptoms include:
- Numbness, tingling, burning or pain in the hands or feet (caused by a condition called "peripheral neuropathy").
- Some patients have high levels of calcium, which can cause increased thirst and urination, constipation and, in extreme cases, decreased alertness and kidney failure.
- In rare cases, patients can have hyperviscosity syndrome, resulting from high concentrations of M protein in the blood, which causes the blood to thicken. Symptoms of hyperviscosity syndrome are abnormal bleeding, headaches, chest pain, decreased alertness or shortness of breath.
- Some patients can have amyloidosis, a condition in which the abnormal myeloma protein is deposited in various tissues in the body and can cause them damage.
If you're troubled by any of the above symptoms, see your doctor. Sometimes, you may have no symptoms. In this case, your doctor may first detect the disease as a result of a lab test or an X-ray taken for another reason.
Doctors sometimes refer to the acronym, CRAB, to describe symptoms of myeloma. The letters stand for
C - Calcium elevation (high levels of calcium in the blood; also known as “hypercalcemia”)
R - Renal insufficiency (poor function of the kidneys that may be due to a reduction in blood-flow to the kidneys)
A - Anemia (low red blood cell counts)
B - Bone abnormalities (lesions).
Patients with one or more of these CRAB criteria are considered to have disease that requires therapy. Those who do not exhibit any of these criteria are said to have “smoldering” or “asymptomatic myeloma,” and these patients may be followed with a watch-and-wait approach. Recently, other criteria that also probably indicate the need to start chemotherapy were added to the CRAB criteria. They include
- At least 60% plasma cells in the bone marrow
- A free light chain ratio (involved light chain /uninvolved light chain) of 100 or more
- More than one focal bone lesion on magnetic resonance imaging (MRI).