10 Multiple Myeloma Symptoms You Should Never Ignore

Multiple myeloma is a type of blood cancer that develops in plasma cells, which are white blood cells found in the bone marrow. When these cells become cancerous, they multiply uncontrollably and accumulate in the bone marrow, crowding out healthy blood cells. This condition, also known as myeloma cancer or bone marrow cancer, can affect multiple areas of the body simultaneously, hence the name “multiple” myeloma.

Understanding the symptoms of multiple myeloma is crucial for early detection and treatment. Many people may not experience any symptoms in the early stages, which is why this condition is often discovered during routine blood tests. However, as the disease progresses, various signs and symptoms begin to manifest. Recognizing these warning signs can help you seek medical attention promptly and improve treatment outcomes.

In this comprehensive guide, we’ll explore the ten most common symptoms of multiple myeloma, helping you understand what to watch for and when to consult with a healthcare professional.

1. Bone Pain and Fractures

Bone pain is one of the most common and earliest symptoms of multiple myeloma, affecting approximately 70% of patients at diagnosis. This pain typically occurs because myeloma cells interfere with the normal bone remodeling process, causing bones to weaken and break down.

The pain is most commonly felt in:

• The back and spine
• Ribs
• Hips
• Skull

The discomfort may be persistent and worsen with movement. Unlike arthritis pain that often improves with activity, myeloma-related bone pain tends to be constant and may become severe. Additionally, weakened bones become susceptible to fractures, even from minor injuries or normal daily activities. These are called pathological fractures, and they can occur spontaneously without any significant trauma.

Compression fractures in the spine are particularly common and can lead to loss of height, spinal deformity, and nerve compression, resulting in numbness or weakness in the legs.

2. Fatigue and Weakness

Persistent, overwhelming fatigue is a hallmark symptom of multiple myeloma that significantly impacts quality of life. This isn’t the normal tiredness you feel after a busy day – it’s a profound exhaustion that doesn’t improve with rest or sleep.

The fatigue associated with myeloma has multiple causes:

• Anemia: Myeloma cells crowd out healthy red blood cells in the bone marrow, leading to decreased oxygen delivery to tissues throughout the body
• Kidney dysfunction: When kidneys don’t work properly, waste products accumulate in the blood, causing fatigue
• High calcium levels: Elevated calcium from bone breakdown can contribute to lethargy and weakness
• The cancer itself: The body’s immune response to cancer can be energy-draining

Patients often describe feeling too tired to perform everyday tasks, experiencing muscle weakness, and having difficulty concentrating or thinking clearly – a phenomenon sometimes called “brain fog.”

3. Frequent Infections

Multiple myeloma significantly weakens the immune system, making patients highly susceptible to recurrent infections. This happens because cancerous plasma cells produce abnormal antibodies that don’t function properly, while simultaneously crowding out healthy plasma cells that produce effective antibodies to fight infections.

Common infections in myeloma patients include:

• Pneumonia and respiratory infections
• Urinary tract infections
• Skin infections
• Shingles (herpes zoster)

These infections may be more severe than usual, take longer to resolve, and recur frequently. Some patients experience infections as their first noticeable symptom of myeloma. If you find yourself getting sick more often than usual, especially with bacterial infections, or if infections seem unusually severe or difficult to treat, it’s important to discuss this with your healthcare provider.

Fever without an obvious source can also be a warning sign, as it may indicate either an infection or the myeloma itself.

4. Kidney Problems

Kidney dysfunction is a serious complication that affects approximately 20-40% of people with multiple myeloma at the time of diagnosis. The kidneys can be damaged through several mechanisms related to this cancer.

Myeloma cells produce abnormal proteins called M proteins or monoclonal proteins. These proteins can accumulate in the kidneys, clogging the delicate filtering structures and impairing kidney function. Additionally, high levels of calcium released from damaged bones can deposit in the kidneys, causing further damage.

Signs of kidney problems include:

• Decreased urine output
• Foamy or bubbly urine (indicating protein in urine)
• Swelling in the legs, ankles, or feet
• Shortness of breath
• Confusion or difficulty concentrating
• Nausea and loss of appetite

In some cases, kidney damage may progress to kidney failure, requiring dialysis. Early detection and treatment of myeloma can help prevent or slow kidney damage, making this an important symptom to recognize and address promptly.

5. Hypercalcemia (High Calcium Levels)

Hypercalcemia, or elevated calcium in the blood, occurs in about 10-15% of multiple myeloma patients at diagnosis and can develop in up to 30% during the course of the disease. This happens because myeloma cells activate osteoclasts – cells that break down bone tissue – releasing calcium into the bloodstream faster than the kidneys can eliminate it.

Symptoms of hypercalcemia include:

• Excessive thirst and frequent urination
• Constipation
• Nausea and vomiting
• Loss of appetite
• Abdominal pain
• Confusion and difficulty concentrating
• Lethargy and extreme fatigue
• Muscle weakness
• Depression

Severe hypercalcemia is a medical emergency that can lead to kidney failure, irregular heart rhythms, and even coma if left untreated. The symptoms can develop gradually and may be mistaken for other conditions, so it’s important to seek medical evaluation if you experience several of these symptoms together, especially if you have other signs of myeloma.

6. Anemia and Related Symptoms

Anemia, a condition characterized by low red blood cell counts, is extremely common in multiple myeloma, affecting approximately 70% of patients. This occurs because cancerous plasma cells crowd the bone marrow, leaving less room for the production of healthy red blood cells.

Red blood cells are responsible for carrying oxygen throughout your body, so when their numbers drop, multiple symptoms can develop:

• Shortness of breath: Especially during physical activity or when lying flat
• Rapid or irregular heartbeat: The heart works harder to compensate for reduced oxygen
• Pale skin, lips, or nail beds: A visible sign of reduced hemoglobin
• Dizziness or lightheadedness: Particularly when standing up quickly
• Cold hands and feet: Due to reduced circulation
• Chest pain: In more severe cases
• Difficulty concentrating: The brain requires significant oxygen to function properly

Anemia in myeloma can range from mild to severe and often contributes significantly to the profound fatigue experienced by patients. It’s typically diagnosed through a simple blood test called a complete blood count (CBC).

7. Neurological Symptoms

Multiple myeloma can affect the nervous system in various ways, leading to a range of neurological symptoms. These occur through several mechanisms, including spinal cord compression from vertebral fractures or tumors, peripheral nerve damage, and the effects of abnormal proteins on nerve function.

Common neurological symptoms include:

• Numbness and tingling: Often starting in the feet and hands, this can spread to other areas
• Weakness in the legs or arms: May affect mobility and coordination
• Sharp, shooting pains: Following nerve pathways
• Loss of bladder or bowel control: A medical emergency indicating spinal cord compression
• Severe back pain with leg weakness: Another sign of potential spinal cord compression
• Confusion or mental changes: Can result from high calcium levels, kidney problems, or rarely, involvement of the brain

Spinal cord compression is a serious complication requiring immediate medical attention. If you experience sudden severe back pain accompanied by numbness, weakness in the legs, or difficulty with bladder or bowel control, seek emergency medical care immediately.

Peripheral neuropathy, while less acute, can significantly impact quality of life, affecting balance, coordination, and the ability to perform fine motor tasks.

8. Weight Loss and Loss of Appetite

Unexplained weight loss is a common symptom in many cancers, including multiple myeloma. Many patients experience significant unintentional weight loss, often losing 10% or more of their body weight without trying.

This weight loss can result from multiple factors:

• Loss of appetite: The cancer itself, along with symptoms like nausea, can reduce the desire to eat
• Changes in metabolism: Cancer can alter how the body processes nutrients
• Nausea and vomiting: Often related to high calcium levels or kidney problems
• Early satiety: Feeling full after eating only small amounts
• Fatigue: Severe tiredness may make eating feel like too much effort
• Altered taste: Food may taste different or unappealing

The loss of appetite and resulting weight loss can create a vicious cycle, as inadequate nutrition further weakens the body and immune system. Patients may also develop nutritional deficiencies that compound other symptoms.

It’s important to note that while some weight fluctuation is normal, persistent, unintended weight loss of more than 5% of your body weight over 6-12 months should be evaluated by a healthcare provider, especially when accompanied by other symptoms.

9. Bleeding and Bruising

Easy bruising and unusual bleeding are symptoms that can occur in multiple myeloma due to low platelet counts (thrombocytopenia). Platelets are blood cells responsible for clotting, and like red and white blood cells, their production can be impaired when myeloma cells crowd the bone marrow.

Signs of low platelet counts include:

• Bruising easily: Developing bruises from minor bumps or appearing without any known injury
• Petechiae: Tiny red or purple spots on the skin, often on the lower legs
• Prolonged bleeding: From minor cuts or after dental procedures
• Frequent nosebleeds: That are difficult to stop
• Bleeding gums: Particularly when brushing teeth
• Heavy menstrual periods: In women who are still menstruating
• Blood in urine or stool: Which may appear red, pink, or black

Additionally, abnormal proteins produced by myeloma cells can interfere with normal clotting function, a condition called acquired bleeding disorder. This can cause bleeding symptoms even when platelet counts are relatively normal.

While mild bruising is common and usually not serious, if you notice a pattern of easy bruising, particularly when combined with other bleeding symptoms or other signs of myeloma, it warrants medical evaluation.

10. Swelling and Fluid Retention

Swelling (edema) can occur in multiple myeloma patients for several reasons, and it typically affects the lower legs, ankles, and feet, though it can also involve the hands, face, or abdomen.

The main causes of swelling in myeloma include:

• Kidney dysfunction: When kidneys don’t properly filter blood and remove excess fluid, it accumulates in tissues
• Low protein levels: Proteins help keep fluid in blood vessels; when levels drop, fluid leaks into surrounding tissues
• Amyloidosis: A complication where abnormal proteins deposit in organs including the heart, potentially causing fluid retention
• Decreased mobility: Due to bone pain and fatigue, leading to pooling of fluid in the legs

Symptoms associated with fluid retention include:

• Swollen, puffy legs, ankles, or feet
• Tight feeling in the skin
• Skin that holds an indentation when pressed (pitting edema)
• Weight gain from fluid accumulation
• Decreased urine output
• Abdominal swelling or bloating
• Shortness of breath if fluid accumulates around the lungs

Sudden or severe swelling, especially when accompanied by shortness of breath, chest pain, or significantly decreased urine output, requires immediate medical attention as it could indicate serious kidney problems or heart complications.

Main Causes of Multiple Myeloma

While the exact cause of multiple myeloma remains unknown, researchers have identified several factors that may contribute to its development. Understanding these factors can help identify who might be at higher risk, though it’s important to note that having risk factors doesn’t mean someone will definitely develop the disease.

Genetic Mutations: Multiple myeloma develops when plasma cells undergo genetic changes that cause them to multiply uncontrollably. These mutations are typically acquired during a person’s lifetime rather than inherited. Chromosomal abnormalities and changes in specific genes have been identified in myeloma cells, though what triggers these changes is not fully understood.

Age: The risk of developing multiple myeloma increases significantly with age. Most people diagnosed are over 65 years old, and it’s rare in people under 40. The median age at diagnosis is approximately 70 years.

Gender: Men are slightly more likely to develop multiple myeloma than women, though the reasons for this difference are not clear.

Race and Ethnicity: Multiple myeloma is approximately twice as common in African Americans compared to Caucasians. People of African descent worldwide have higher rates of this cancer. The reasons for this disparity are being studied and likely involve both genetic and environmental factors.

Family History: Having a parent or sibling with multiple myeloma or MGUS (monoclonal gammopathy of undetermined significance) increases the risk, suggesting some genetic predisposition. However, most people with myeloma do not have a family history of the disease.

MGUS (Monoclonal Gammopathy of Undetermined Significance): Almost all cases of multiple myeloma are preceded by MGUS, a condition where abnormal plasma cells produce M proteins but don’t cause symptoms or serious problems. MGUS progresses to myeloma at a rate of about 1% per year. However, most people with MGUS never develop myeloma.

Obesity: Being overweight or obese has been linked to an increased risk of developing multiple myeloma. Maintaining a healthy weight may help reduce this risk.

Environmental and Occupational Exposures: Some studies suggest that exposure to certain chemicals, pesticides, and radiation may increase myeloma risk, though the evidence is not conclusive. People who worked in agriculture, petroleum-related industries, or were exposed to high levels of radiation may have elevated risk.

Weakened Immune System: Conditions or medications that suppress immune function may increase the risk of developing multiple myeloma, though this connection is not fully established.

Frequently Asked Questions

What is the difference between multiple myeloma and other blood cancers?

Multiple myeloma specifically affects plasma cells in the bone marrow, whereas other blood cancers like leukemia affect different types of blood cells. Lymphoma affects lymphocytes in the lymphatic system. Myeloma is characterized by the production of abnormal proteins and typically affects bones, while leukemia primarily affects blood and bone marrow, and lymphoma affects lymph nodes and other lymphatic tissues.

Can multiple myeloma be detected early?

Multiple myeloma is often difficult to detect early because symptoms may not appear until the disease has progressed. Many cases are discovered incidentally during routine blood tests that show abnormal protein levels or anemia. Regular health checkups and blood tests are important, especially for people with MGUS or other risk factors.

Is multiple myeloma hereditary?

While having a family member with multiple myeloma does slightly increase your risk, the disease is not directly inherited in most cases. The genetic mutations that cause myeloma are typically acquired during a person’s lifetime rather than passed from parents to children. However, genetic factors may influence susceptibility to developing the condition.

What is MGUS and how does it relate to multiple myeloma?

MGUS (Monoclonal Gammopathy of Undetermined Significance) is a condition where abnormal plasma cells produce M proteins, but not enough to cause symptoms or serious health problems. Nearly all multiple myeloma cases develop from MGUS, though only about 1% of people with MGUS progress to myeloma each year. Most people with MGUS never develop myeloma and require only monitoring.

How is multiple myeloma diagnosed?

Diagnosis typically involves multiple tests including blood tests to detect M proteins and check blood cell counts, urine tests to look for abnormal proteins, bone marrow biopsy to examine plasma cells, imaging tests (X-rays, MRI, CT, or PET scans) to look for bone damage, and other specialized tests. A combination of these tests helps confirm the diagnosis and determine the stage of the disease.

What is the CRAB criteria?

CRAB is an acronym used to remember the main features of active multiple myeloma: C (Calcium elevation/hypercalcemia), R (Renal/kidney failure), A (Anemia), and B (Bone lesions). The presence of one or more CRAB features, along with evidence of abnormal plasma cells, typically indicates that treatment is needed.

Can younger people get multiple myeloma?

While multiple myeloma is most common in people over 65, younger individuals can develop it, though it’s rare. When it occurs in younger people, it may be more aggressive but may also respond better to treatment. Any persistent unexplained symptoms should be evaluated by a healthcare provider regardless of age.

Are the symptoms of multiple myeloma constant or do they come and go?

Symptoms can vary in intensity and may come and go, especially in early stages. Some symptoms like bone pain may be intermittent initially but typically become more persistent as the disease progresses. Fatigue and weakness often fluctuate but generally worsen over time. This variability can sometimes make diagnosis challenging.

When should I see a doctor about these symptoms?

You should consult a healthcare provider if you experience persistent bone pain, unexplained fatigue that doesn’t improve with rest, frequent infections, unexplained weight loss, or any combination of symptoms mentioned in this article. While these symptoms can have many causes, it’s important to get evaluated, especially if symptoms persist for more than a few weeks or progressively worsen.

What should I do if I’m diagnosed with multiple myeloma?

If diagnosed with multiple myeloma, work closely with a healthcare team, preferably including a hematologist-oncologist who specializes in blood cancers. They will develop a personalized treatment plan based on your specific situation. It’s important to attend all appointments, ask questions, seek support from family, friends, or support groups, and maintain the best possible overall health through good nutrition and appropriate activity levels.

References:

• American Cancer Society – Multiple Myeloma
• Mayo Clinic – Multiple Myeloma
• National Cancer Institute – Multiple Myeloma
• NHS – Multiple Myeloma
• International Myeloma Foundation
• Leukaemia Foundation – Myeloma