When multiple myeloma is diagnosed, the medical team will examine and determine the extent of the growth, which is known as the stage of the cancer. The stage is an important factor in treatment decisions, and it is often determined through blood and other diagnostic tests.
There are two common methods for staging myeloma: Durie-Salmon staging and the International Staging System. These classifications use slightly different measurements to determine the severity of the cancer and the effect on the kidneys. With both, the higher the stage, the more cancer has been detected in the body and the more aggressive the treatment may be.
Understanding the different descriptions for cancer.
There are a few terms that can be used to describe multiple myeloma. Each has a different level of treatment.
Smoldering multiple myeloma is sometimes called “asymptomatic myeloma.” In this stage, the person has a high number of myeloma cells—and possibly anemia—but no other typical myeloma symptoms. The treatment choice is often watchful waiting, which is exactly what it sounds like: close monitoring of the cancer without deeper treatment. People with smoldering myeloma can go years without progression. Sometimes the condition does progress, so those who have smoldering myeloma should meet frequently with their health care team. Studies are currently underway to determine if drug therapy helps these patients.
Active or symptomatic myeloma is when the disease is causing damage to the body. This damage can include anemia, difficulties with kidney function, damage to the bones, or hypercalcemia (high levels of calcium in the blood). Treatment for this stage is determined by a number of factors, including the patient’s overall health, the spread of the cancer, whether the kidneys are functioning properly, and the risk of myeloma returning once the treatment course has ended.
Treatments for early stage active myeloma may include chemotherapy, radiation therapy, and possibly a stem cell transplant—often after other treatments have removed harmful cancer cells. The good news is that there are many options to try. If one medication or approach doesn’t work, another might be more effective. Because myeloma often prevents the body from producing healthy white blood cells, people with myeloma may also be given blood transfusions or antibiotics to help prevent or treat infections.
Treatment length and what to expect.
Your health care team may include your primary care doctor, a hematologist, an oncologist, a radiation oncologist, a dentist, and a pharmacist. They’ll all work together to help make sure you get the best care.
Your practitioners will closely monitor your treatment and conduct follow-up tests to see how the treatment regimen is working. Depending on the size, spread, and type of cancer, treatment can last from a few days to a few weeks or months. Just about all treatments for cancer cause some type of side effect, but they can be particularly pronounced for myeloma patients. See our article on myeloma treatment side effects, and talk to your doctor about ways to lessen or treat side effects.