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How does multiple myeloma
How does multiple myeloma spread?

Unlike most types of cancer, it is thought that multiple myeloma spreads via the blood. Abnormal plasma cells can be released from a concentration of bone marrow in one part of the body, such as the spine.

The plasma cells are then able to travel away from the spine and affect other concentrations of bone marrow that are a long way from the spine, such as the hips or the skull.

The fact that the cancerous plasma cells can quickly spread through the body is the reason why, at the current time, a complete cure for multiple myeloma is not possible


Biopsy
A biopsy is the final stage in confirming a diagnosis of multiple myeloma. During a biopsy a needle is used to take a small sample of bone marrow from one of your bones, usually the hip. The biopsy will be carried out under a local anaesthetic so that it is not painful. The sample of bone marrow will be studied in a laboratory to check whether there are any cancerous plasma cells present. A pathology report will have info that can help Dr determine how quickly the cancer is spreading by values such as Grade, mitosis rate (division of cancer cells) nuclear values, and behavior of cancer cells in terms of how much they resemble or are differientiated with healthy cells.

Stages

Stage one
During stage one, the cancer is still in a very early stage of development. Levels of calcium are normal, levels of red blood cells are normal (or slightly below normal), and there are only low levels of paraproteins in the blood.

Your bones will be undamaged, or only slightly damaged. Most people will not experience any symptoms during this phase.

Stage two
During stage two, the level of red blood cells, paraproteins, and calcium in the blood are still relatively normal, but damage to one or two bones may have taken place.

Stage three
During stage three, the cancer has now reached an advanced state. Levels of red blood cells have dropped and it is likely that there will be symptoms of anaemia.

Similarly, your levels of calcium will have risen and it is likely that you will have symptoms of hypercalcaemia (excessive levels of calcium in the blood). There will be high levels of paraproteins in your blood, and damage will have occurred to three or more bones.

The Durie-Salmon system also uses a lettering system to describe the state of the kidneys:

A - the kidneys are undamaged, or only minimally damaged, and
B - the kidneys have been damaged and kidney function is abnormal.
Kidney damage can occur at any stage, although it usually only happens during stage two or three.

In cases of stage one multiple myeloma, a policy of watchful waiting is usually recommended. This means that you will not receive any immediate treatment but your health will be carefully monitored in case the cancer progresses.

In cases of stage two and three multiple myeloma, chemotherapy treatment is usually recommended.