To be able to have the appropriate treatment after being diagnosed with cancer, determining the stage in which the cancer has spread needs to be done.
When it comes to multiple myeloma, a number of symptoms may be experienced and taking a closer look to determine the stage will be essential.
Knowing the fact that not all symptoms are usually visible especially at the first stage, being aware of each specific stages should help in disease management.
Multiple Myeloma Stages
Multiple myeloma stages are used to identify the progress or degree of the cancer.
The size and spread of tumors are usually used as a basis in staging most cancers. However, when it comes to multiple myeloma stages, several factors should be considered such as protein levels in the blood and urine, blood cell counts, the level of calcium in the blood and other diagnostic test results.
Two ways can be used in staging multiple myeloma. Both methods places myeloma into three stages which is designated by Roman numerals I-III. The two multiple myeloma staging methods differentiate in the factors being evaluated:
A. The Durie-Salmon System evaluates the levels of calcium, monoclonal immunoglobulin and hemoglobin in the blood. It also assesses the amount of bone lesions to identify the severity of bone damage. The method is now becoming less used.
- Stage I: There are no visible symptoms in many patients with stage I myeloma. It is because of a few amount of cancer cells. However, if cancer cells impair kidney function, it can be worse irrespective of myeloma stage.
- Stage II: The presence of cancer cells are higher. Any effect on kidney function makes the prognosis worse irrespective of the stage. The criteria for stage II identification is described as factors that neither fits stage I nor stage III.
- Stage III: Along with specific value results is an evident increase in the amount of cancer cells in the body.
B. The International Staging System in the evaluation multiple myeloma depend on two main factors: the levels of beta-2-microglobulin and albumin in the blood.
- Stage I: Albumin greater than or equal to 3.5 gm/dL. β2-M less than 3.5 mg/L.
- Stage II: Eitheralbumin less than 3.5 g/dL and/or β2-M greater than 3.5 mg/L but not greater than 5.5 mg/dL.
- Stage III: β2-M greater than 5.5 mg/L.
A few aspects on multiple myeloma stages
1. Initially not visible
The initial onset of multiple myeloma is usually not visible with the presence of any symptoms and only a test can determine its presence. In this case the number of red blood cells is usually just slightly below normal levels but never life threatening. However, it may still stay within the normal range.
2. Initial stage presents normal amounts of calcium
For accurate prognosis in determining an early stage, it usually displays normal amounts of calcium in the blood. This can mean that with the right treatment at this early stage, the disease can be managed more effectively.
3. Traces of Protein in the Blood or Urine
One of the whistle blowers to determine if a person is suffering from myeloma is the amount of monoclonal immunoglobulin, usually called protein M, in the blood and urine. At stage 3, the traceable amounts will be found to display high levels when evaluated in blood or urine.
4. There may be no visible damage
With the advancement of cancer detection technology, the body can also be identified of myeloma bone damage. However, at an early stage, there may be no visible bone damage that can be detected on x-rays. Bone damage on multiple areas indicate an advanced stage.
5. Rise in the number cancer cells
The speed of growth for myeloma cancer cells can be detected with myeloma cell labeling index. Its aggressiveness can be determined from the abnormalities of chromosomes in the cancer cells. Results may show a steady rise in the number of cancer cells in the body.
6. Kidney function
With the number of cancer cells rising in the body, stage advancement can be determined depending on how kidney function is affected. The health of the kidneys can be identified by blood creatinine levels. When the kidneys are damaged by M protein, creatinine level increases.
There are about 2/3 of affected individuals at the time of diagnosis who display anemia. This is usually seen at stage III that can be identified when hemoglobin level is found to be less than 8.5 gm/dL. Symptoms include weakness, fatigue, and paleness.
8. Increased Calcium
The presence of hypercalcemia can be found at an advanced stage. This means that the calcium levels in the blood samples tested to be way above normal levels. It happens due to the breakdown of bones in multiple myeloma which is rich in calcium. Due to increased levels, kidney stones and abnormal functioning of heart and brain, may develop.
9. Bone damage
Advanced bone damage is found at stage III, which may include lytic lesions, compression fracture of the spine and osteoporosis. More than three bone lesions are considered advanced bone damage.
10. High levels of abnormal protein M
An advanced multiple myeloma stage also presents extremely high levels of protein M in the blood and urine. It may be responsible to any bleeding problems, thickness of the blood or kidney damage.
It is good to note that even after determining the stage a person is suffering from; multiple myeloma is still seldom cured but can be managed by certain treatments in order to relieve symptoms and prolong life.
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