Multiple myeloma history and symptoms: Difference between revisions

	Multiple myeloma Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Multiple Myeloma from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Criteria
Staging
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X Ray
Echocardiograph and Ultrasound
CT
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Future or Investigational Therapies
Case Studies
Case #1
Multiple myeloma history and symptoms On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Multiple myeloma history and symptoms All Images X-rays Echo and Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Multiple myeloma history and symptoms
CDC on Multiple myeloma history and symptoms
Multiple myeloma history and symptoms in the news
Blogs on Multiple myeloma history and symptoms
Directions to Hospitals Treating Multiple myeloma
Risk calculators and risk factors for Multiple myeloma history and symptoms

← Older edit Newer edit →

VisualWikitext

Revision as of 15:09, 17 September 2015

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The presenting symptoms of multiple myeloma may vary greatly due to involvement of many organ systems. A mnemonic sometimes used to remember the common tetrad of multiple myeloma is CRAB - C = Calcium (elevated), R =Renal failure, A = Anemia, B = Bone lesions.^[1]

History

Early multiple myeloma does not have any symptoms.
In as many as 30-40% cases the diagnosis may be incidental and is often diagnosed on routine blood screening.
A rise in total protein levels without a concomitant rise in albumin levels must make the physician suspicious for a possibility of multiple myeloma.
As the tumor grows larger people may notice one or more of the symptoms.

Common Symptoms

Bone pain
Pathological fractures
Numbness and/or muscle weakness
Confusion
Dizziness
Edema in legs
Back pain, numbness, dysthesias suggestive of spinal cord compression.
Bleeding
Recurrent infections

References

↑ International Myeloma Working Group. Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group. Br J Haematol 2003;121:749-57. PMID 12780789.

Template:WikiDoc Sources

[IMWG-1] International Myeloma Working Group. Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group. Br J Haematol 2003;121:749-57. PMID 12780789.

[1]

@@ Line 3: / Line 3: @@
 {{CMG}}
 ==Overview==
-The signs and symptoms of multiple myeloma are most commonly associated with either elevation in [[calcium]] concentrations, [[renal failure]], [[anemia]] and involvement of the [[bone]]s such as fractures and pains.
+The presenting symptoms of multiple myeloma may vary greatly due to involvement of many organ systems. A [[mnemonic]] sometimes used to remember the common tetrad of multiple myeloma is ''CRAB'' - C = Calcium (elevated), R =Renal failure, A = Anemia, B = Bone lesions.<ref name="IMWG">International Myeloma Working Group. ''Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group.'' Br J Haematol 2003;121:749-57. PMID 12780789.</ref>
+==History==
-==History and Symptoms==
+*Early multiple myeloma does not have any symptoms.
-Early multiple myeloma does not have any symptoms. In as many as 30-40% cases the diagnosis may be incidental and is often diagnosed on routine blood screening. A rise in total protein levels without a concomitant rise in albumin levels must make the physician suspicious for a possibility of multiple myeloma. As the tumor grows larger, people may notice one or more of the following symptoms:
+*In as many as 30-40% cases the diagnosis may be incidental and is often diagnosed on routine blood screening.
+*A rise in total protein levels without a concomitant rise in albumin levels must make the physician suspicious for a possibility of multiple myeloma.
+*As the tumor grows larger people may notice one or more of the symptoms.
+==Common Symptoms==
 :*[[Bone pain]]
 :* Pathological fractures
@@ Line 16: / Line 19: @@
 :* Bleeding
 :* Recurrent infections
-Because many organs can be affected by multiple myeloma, the symptoms and signs vary greatly. A [[mnemonic]] sometimes used to remember the common tetrad of multiple myeloma is ''CRAB'' - C = Calcium (elevated), R =Renal failure, A = Anemia, B = Bone lesions.<ref name="IMWG">International Myeloma Working Group. ''Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group.'' Br J Haematol 2003;121:749-57. PMID 12780789.</ref> Multiple myeloma has many possible symptoms, and all symptoms may be due to other causes. They are presented here in decreasing order of incidence.
-;Bone pain
-Multiple myeloma bone pain usually involves the spine and ribs, and worsens with activity. Persistent localized pain may indicate a pathological [[bone fracture]]. Involvement of the vertebrae may lead to [[spinal cord compression]]. Multiple myeloma bone disease is due to proliferation of tumor cells and release of [[Interleukin 6|IL-6]], also known as osteoclast activating factor (OAF), which stimulates [[osteoclast]]s to break down bone. These bone lesions are lytic in nature and are best seen in plain radiographs, which may show a "punched-out" resorptive lesions. The breakdown of bone also leads to release of [[calcium]] into the blood, leading to [[hypercalcemia]] and its associated symptoms.
-;Infection
-The most common infections are [[pneumonia]]s and [[pyelonephritis]]. Common pneumonia pathogens include ''[[streptococcus pneumoniae|S pneumoniae]]'', ''[[staphylococcus aureus|S aureus]]'', and ''[[klebsiella pneumoniae|K pneumoniae]]'', while common pathogens causing pyelonephritis include ''[[escherichia coli|E coli]]'' and other [[gram-negative]] organisms. The increased risk of infection is due to immune deficiency resulting from diffuse [[hypogammaglobulinemia]], which is due to decreased production and increased destruction of normal [[antibody|antibodies]].
-;Renal failure
-[[Renal failure]] may develop both [[acute renal failure|acutely]] and [[chronic renal failure|chronically]]. It is commonly due to [[hypercalcemia]] (see above). It may also be due to tubular damage from excretion of [[light chain]]s, also called [[Bence Jones protein]]s, which can manifest as the [[Fanconi syndrome]] (type II [[renal tubular acidosis]]). Other causes include glomerular deposition of [[amyloid]], [[hyperuricemia]], recurrent infections ([[pyelonephritis]]), and local infiltration of tumor cells.
-;Anemia
-The [[anemia]] found in multiple myeloma is usually normocytic and normochromic. It results from the replacement of normal bone marrow by infiltrating tumor cells and inhibition of normal red blood cell production ([[hematopoiesis]]) by [[cytokines]].
-;Neurological symptoms
-Common problems are weakness, confusion and fatigue due to [[hypercalcemia]]. [[Headache]], visual changes and [[retinopathy]] may be the result of hyperviscosity of the blood depending on the properties of the [[paraprotein]]. Finally, there may be [[radicular pain]], loss of bowel or bladder control (due to involvement of [[spinal cord]] leading to cord compression) or [[carpal tunnel syndrome]] and other [[neuropathies]] (due to infiltration of [[peripheral nerves]] by [[amyloid]]).  It may give rise to [[paraplegia]] in late presenting cases.