Multiple myeloma

Definition

Multiple myeloma is cancer of the plasma cells in bone marrow.

Alternative Names

Plasma cell dyscrasia; Plasma cell myeloma; Malignant plasmacytoma; Plasmacytoma of bone; Myeloma - multiple

Causes

Plasma cells help the body's immune system fight disease by producing proteins called antibodies. In multiple myeloma, plasma cells grow out of control in the bone marrow and form tumors in the areas of solid bone.
The growth of these bone tumors makes it harder for the bone marrow to make red blood cells, white blood cells, and platelets. This causes anemia, which makes a person more likely to get infections and have abnormal bleeding.
As the cancer cells grow in the bone marrow, they can cause pain and destruction of the bones. If the bones in the spine are affected, it can put pressure on the nerves, resulting in numbness or paralysis.
Multiple myeloma mainly affects older adults. A history of radiation therapy raises your risk for this type of cancer.

Symptoms

• Bleeding problems
• Bone or back pain, most often in the ribs or back
• Fevers without any other cause
• Increased susceptibility to infection
• Symptoms of anemia (such as tiredness, shortness of breath, and fatigue)
• Unexplained fractures
• Weakness of the arms or legs

Exams and Tests

Blood tests can help diagnose this disease. They may include:

• Blood chemistry may show increased levels of calcium, total protein, and abnormal kidney function
• Complete blood count (CBC) reveals low numbers of red and white blood cells and platelets
• Serum beta 2 microglobulin level
• Serum immunofixation electrophoresis
• Urine immunofixation electrophoresis
• Serum protein electrophoresis (SPEP)
• Urine protein electrophoresis (UPEP) or Bence-Jones protein analysis
• Quantitative immunoglobulins (nephelometry)
• Serum free light chain measurements

Bone x-rays may show fractures or hollowed out areas of bone. If your doctor suspects this type of cancer, a bone marrow biopsy will be performed.
Bone density testing may show bone loss.

Treatment

The goal of treatment is to relieve symptoms, avoid complications, and prolong life.
People who have mild disease or where the diagnosis is not certain are usually carefully watched without treatment. Some people have a slow-developing form of multiple myeloma that takes years to cause symptoms.
Medications for the treatment of multiple myeloma include:

• Dexamethasone, melphalan, thalidomide, lenalidomide (Revlimid), and bortezomib (Velcade) can be used alone or together.
• Drugs called bisphosphonates (pamidronate) are used to reduce bone pain and prevent fractures.

Radiation therapy may be performed to relieve bone pain or treat a bone tumor.
Two types of bone marrow transplantation may be tried:

• Autologous bone marrow or stem cell transplantation makes use of ones own stem cells. In younger patients, it has been shown to increase survival.
• Allogeneic transplant makes use of someone elses stem cells. This treatment carries serious risks.

People with multiple myeloma should drink plenty of fluids to prevent dehydration and help maintain proper kidney function. They should also be cautious when having x-ray tests that use contrast dye.

Support Groups

The stress of illness may be eased by joining a support group whose members share common experiences and problems. See: Cancer - support group

Outlook (Prognosis)

Survival of people with multiple myeloma depends on the patient's age and the stage of disease. Some cases are very aggressive, while others take years to get worse.
Chemotherapy and transplants rarely lead to a permanent cure.

Possible Complications

Kidney failure is a frequent complication. Other complications may include:

• Bone fractures
• High levels of calcium in the blood, which can be very dangerous
• Increased chances for infection (especially pneumonia)
• Paralysis from tumor or spinal cord compression

Mesothelioma - What is Mesothelioma

Mesothelioma is a type of cancer that is primarily caused by exposure to certain types of asbestos, a material once used in building construction. The disease can affect the lungs, the abdomen, or the heart. There are three types of mesothelioma:

• Pleural: Pleural mesothelioma affects the pleura - the lining of the lungs. It is the most common type of mesothelioma.
• Peritoneal: Peritoneal mesothelioma affects the peritoneum - the lining of the abdomen.
• Pericardial: Pericardial mesothelioma affects the pericardium, the membrane that surrounds the heart. It is the least common type, affecting about 5 percent of people with the disease.

Causes of Mesothelioma

Asbestos exposure is the number one cause for mesothelioma. Asbestos is a fibrous mineral that was once found in many types industrial building supplies and equipment. Asbestos was used until the mid 1970's when the risks of exposure were becoming evident. It is still used today, yet in a very limited capacity.

Asbestos exposure doesn't result immediately in cancer. It takes years for the cancer to form and cause symptoms. Workers exposed in the 1950's, 60's, and 70's are just now being diagnosed with mesothelioma.

Symptoms of Mesothelioma

Symptoms of mesothelioma do not appear immediately after being exposed, taking about 25 to 50 years after the initial exposure to develop. It is a very slow progressing disease that usually strikes middle age to senior adults long after their exposure to asbestos.

Symptoms of mesothelioma vary based on the type of mesothelioma, but general symptoms include:

• shortness of breath
• chest pain
• persistent cough
• wheezing
• abdominal swelling
• abdominal pain
• changes in bowel habits
• abdominal mass

Many of these symptoms are non-specific, meaning they aren't exactly red flags for mesothelioma. However, when combined with previous exposure to asbestos, it may suggest to your physician to evaluate for mesothelioma. It is very important that your doctor is aware of any prior exposure to asbestos. Mesothelioma is also a rare disease, so it can be overlooked in the diagnostic process.

Diagnosing Mesothelioma

Mesothelioma diagnosis is difficult as the symptoms are very similar to many other diseases and conditions. With any respiratory symptoms, a chest x-ray is usually the first step in getting a diagnosis for any lung related condition. Many people with mesothelioma have a pleural effusion that is seen on the chest x-ray. A pleural effusion is a condition marked by the accumulation of fluid between the lung and chest wall.

Other imaging tests, like MRI, CT scans, and PET scans may be used to examine the chest and abdomen to investigate for abnormalities.

Ultimately, it is a biopsy that confirms or rules out mesothelioma. A biopsy is the removal of a small amount of tissue to be examined by a pathologist. A biopsy to screen for mesothelioma is done during a procedure called a thoracoscopy.

If mesothelioma is confirmed through microscopic analysis by a pathologist, it is then necessary to determine how advanced the mesothelioma is and to develop a treatment plan.

Treatment of Mesothelioma

This section references pleural mesothelioma, the most common type of mesothelioma.

Treatment of mesothelioma varies based on how far the disease has advanced and factors like age and other health considerations like cardiopulmonary function. In most cases of mesothelioma, surgery is performed to palliatively relieve the symptoms or complications of the disease, not necessarily to cure it. Surgery, combined with other methods of treatment, may increase life span, however. Rarely is surgery performed with a goal of "curing" mesothelioma. Surgery performed to treat mesothelioma include:

• Pleurectomy: This type of surgery is reserved for early stage mesothelioma patients. During a pleurectomy, part of the pleura is removed, in attempt to eliminate all cancerous tissue. Sometimes during pleurectomy surgery, it is evident that a pluerectomy will not be effective at removing all cancerous tissue and a more aggressive surgery may be done instead, like a pneumonectomy.
• Extrapleural Pnemonectomy:

This type of surgery removes the lung, the pleura, pericardium, and a good portion of the diaphragm. It is a very aggressive surgery and is reserved for those who have the lung and heart function to sustain such a surgery. Only physicians highly experienced in extrapleural pneumonectomy surgery should perform it. It is a very complex procedure and even those who may be healthy enough to undergo it, choose not to.

Pleural effusions are common with people with mesothelioma and can cause severe breathing difficulties and chest pain. The fluid can be drained and a procedure called pleurodesis can be done to prevent effusions from recurring. Again, not a curative approach, but certainly one that increases quality of life and reduces pain and discomfort.

Radiation Therapy to Treat Mesothelioma

Radiation therapy is also an option for treating some people with mesothelioma. This type of treatment uses certain types of high-energy beams of radiation to shrink tumors or eliminate cancer cells. Radiation therapy works by damaging a cancer cell's DNA, making it unable to multiply. Although radiation therapy can damage nearby healthy cells, cancer cells are highly sensitive to radiation and typically die when treated. Healthy cells that are damaged during radiation are resilient and are often able to fully recover.

In mesothelioma, radiation therapy is utilized as adjuvant therapy, given along with surgery or chemotherapy. Sometimes all three methods are used in a treatment sequence called, trimodality therapy.

Chemotherapy may be prescribed to treat mesothelioma. Treatment drugs work by eliminating rapidly multiplying cancer cells; however, there are other healthy cells in the body that multiply just as quickly, such as hair follicle cells. Unfortunately, many chemotherapy drugs may not be able to discern the two, attacking healthy cells and causing side effects, such as hair loss.

When an oncologist recommends chemotherapy for someone with mesothelioma, a type of therapy called combination therapy is often the prescribed treatment. Combination therapy utilizes two chemotherapy drugs instead of just one, which has been found to be more effective in mesothelioma. Alimta is one of the most common drugs used in combination therapy chemotherapy drugs used in mesothelioma. It is often used in conjunction with cisplatin, Again, like other treatments, the intent of chemotherapy is not curative - it is to improve quality of life by supressing and treating symptoms and complications of the disease. 

Melanoma

Melanoma is a potentially dangerous type of skin cancer. It is diagnosed less frequently than other types of skin cancer (nonmelanoma skin cancer), but has the ability to spread very quickly. Melanoma most often begins on the skin but can develop on the other parts of the body, such as under fingernails, toenails and the eyeball.

Causes and Risk Factors of Melanoma

While we don't know exactly what causes melanoma, we do know that there are risk factors that increase the likelihood that we may develop the disease. Risk factors for melanoma include:

• unprotected exposure to UV radiation from natural sunlight or artificial sources, such as tanning beds/lamps
• being white with fair skin and also having naturally red hair
• family or personal history of melanoma
• having many moles (more than 50)
• being older, although it can occur in young people also
• being male
• having many freckles
• a history of sunburns
• developing freckles easily

Keep in mind that people of all races and complexions can develop melanoma; it is not limited to fair-skinned whites.

Symptoms of Melanoma

Change in an existing mole is usually the first experienced symptom in people with melanoma. A new suspicious skin mole is also something that should raise red flags.

Learning the difference between a normal mole and an abnormal mole can help with self-skin exams at home. The ABCDs of melanoma can help you to discern between what is normal and what may need further evaluation by a dermatologist. The ABCDE rule guidelines instruct you to look for these characteristics in moles:

• Asymmetry: Normal moles or freckles are completely symmetrical. If you were to draw a line through a normal spot, you would have two symmetrical halves. In cases of skin cancer, spots will not look the same on both sides.
  
• Border: A mole or spot with blurry and/or jagged edges.
  
• Color: A mole that is more than one hue, color or shade is suspicious and needs to be evaluated by a doctor. Normal spots are usually one color. This can include lightening or darkening of the mole.
  
• Diameter: If the mole is larger than a pencil eraser (about 1/4 inch or 6mm), it needs to be examined by a doctor. This includes areas that do not have any other abnormalities (color, border, asymmetry).

Keep in mind that a mole does not have to meet the complete ABCD criteria to be evaluated by a dermatologist. Anything that meets at least one rule should be examined by a health care professional, preferably by a dermatologist.

Evolution: Evolution refers to change, and in thw case of melanoma, change to existing moles. Looking for changes in the size, symetry, border, and color.

Diagnosis of Melanoma

Diagnosing skin cancer first begins with the discovery of a suspicious mole or change in the appearance of a mole on the skin. Abnormalities can be detected at home through self-skin exams or through a clinical skin exam done by a doctor. A clinical skin exam should be part of your physical, or if you are at a higher risk of melanoma, it should be done more often by a dermatologist.

If skin cancer is suspected, a biopsy must be done to confirm the presence or absence of cancer. A skin biopsy can be done in several ways, and most of them can be done in-office with a local anesthetic, depending on size and location.

If biopsy results show the presence of melanoma, more tests may be needed to determine how far the disease has spread. These tests can include chest x-rays, liver function tests and other tests as determined by your physician.

Treatment of Melanoma

There are currently four methods of treating melanoma: surgery, chemotherapy, radiation therapy and immunotherapy. Treatment depends on how far the cancer has spread, age and overall general health.

For those with early stages of melanoma, surgery to remove the area in question, along with a small margin of healthy surrounding tissue, may be all that is needed for treatment. This may also include having a sentinel node biopsy to ensure that the cancer has not spread.

If the cancer is more advanced and has spread, chemotherapy and immunotherapy may be necessary for treatment. Radiation therapy may be used in select cases.

Prevention of Melanoma

Skin cancer may be the most common type of cancer, but it is also the most preventable types as well. The first step in preventing skin cancer is to avoid UV ray exposure. We can do this by:

Wearing Sunscreen. You have heard it a million times, but sunscreen really is one of your best bets in preventing skin cancer, especially if you spend a lot of time outdoors. Experts recommend choosing a sunscreen that is at least SPF 15 or higher. Don't forget to reapplyevery two hours, after swimming, and if you become sweaty.

• Common Sunscreen Mistakes
• How to Apply Sunscreen
• How to Choose the Right Sunscreen for Your Skin
• Do You Need Sunscreen for Your Lips?

Avoiding Mid-Day Sun. Avoid going outdoors from 10 a.m. to 4 p.m. This is when the sun's rays are brightest, causing the most damage to skin. If you have to go outdoors, be sure to lather on sunscreen.

• Best Ways to Take Your Walking Indoors
• Fun Indoor Activities for Kids

Wearing Protective Clothing. Wearing hats and clothing that cover the skin are excellent ways to reduce your risk of skin cancer. Eyes are also susceptible to sun damage, so be sure to wear sunglasses that have UV protection.

Staying Shady. Staying in the shade will not only keep you cooler, it will reduce your risk of UV exposure. Though you are in the shade, you will still need to wear sunscreen.

Avoiding Tanning Beds/Booths. Artificial UV exposure is not any safer than natural exposure. Some studies even suggest that tanning beds and booths increase your risk of melanoma, a dangerous form of skin cancer.

• Which Self Tanners Work Best?
• How to Fake a Summer Tan
• The Effects of Sun on the Skin

Lymphoma: What is Lymphoma?

Lymphoma is a type of cancer that affects our lymphatic system. There are main groups of lymphoma: Hodgkin's lymphoma and non-Hodgkin's lymphoma. These two groups encompass about 30 different types of lymphoma.

Lymphoma develops in the lymphatic system, part of the immune system that helps filter out bacteria and fight disease. Most of us are familiar with the term lymph nodes, and they can become swollen in normal situations at any time in our lives — usually when we are sick or have an infection. When the cells in the lymph nodes begin to multiply rapidly, become malignant, and the developing condition is lymphoma.

Hodgkin's Lymphoma and Non-Hodgkin's Lymphoma

There are two main groups of lymphoma: Hodgkin's lymphoma and non-Hodgkin's lymphoma.

Non-Hodgkin's lymphoma is a term that encompasses a variety of cancers affecting the immune system. There are more than twenty different types of non-Hodgkin's lymphoma.

• Video: What is Non-Hodgkin's Lymphoma
• The Basics of Non-Hodgkin's Lymphoma

Another type of lymphoma, Hodgkin's lymphoma, affects lymph tissue in the lymphatic system but can spread to the lungs, bone marrow and blood.

Causes and Risk Factors of Lymphoma

Unfortunately, researchers cannot exactly pinpoint what causes lymphoma. They have, however, identified risk factors for the disease. In general, lymphoma can develop in anyone, whether or not you display some of the risk factors attributed to the disease. Though there are factors that have been found in people with lymphoma, having some or none of the factors does not determine that a person will or will not develop the cancer.

Age. Lymphoma can develop in both children and adults, but the majority of people diagnosed are usually older than the age of 60. Many cases where children have developed the disease is when they have a pre-existing immune system deficiency.

Weak immune system. Other illnesses or diseases, such as HIV/AIDS, weaken the immune system and can make the body more susceptible to lymphoma.

Family history. Although rare, certain inherited lymphoma syndromes do exist, increasing the likelihood of developing lymphoma.

Infections. Illnesses, such as HIV/AIDS, Epstein-Barr virus, Hepatitis C and Helicobacter pylori, are all factors that can increase the risk of developing lymphoma.

Studies are now being done to see if there is a relationship between obesity and certain herbicides and chemicals in the development of lymphoma.

Radiation. People exposed to high levels of radiation, such as survivors of nuclear reactor accidents and atomic bombs, are at an increased risk for developing non-Hodgkin's lymphoma. People who also had previous radiation therapy are also at a higher risk for lymphoma.

Symptoms of Lymphoma

General symptoms of lymphoma include swelling of a lymph node, unintended weight loss, fatigue, night sweats, fevers and feeling itchy without an apparent cause.

• Signs and Symptoms of Lymphoma
• Are Enlarged Lymph Nodes Always a Sign of Lymphoma?

Diagnosis of Lymphoma

Lymphoma is normally suspected during routine examinations or, in some cases, when a person feels a swollen lymph node that does not go away or returns. A person may experience other symptoms of lymphoma that prompt them to see a doctor.

To make a diagnosis of lymphoma, a series of medical tests are performed to confirm a suspicion of lymphoma. Ultimately, it is a biopsy that will determine the presence or absence of cancer. A biopsy is the removal of a small amount of tissue to be studied later under a microscope. People who are suspected to have lymphoma will undergo a lymph node biopsy

A biopsy sample will also determine the type of lymphoma, if cancer is present, based on how the cells look under a microscope. After the type has been defined, more tests will need to be done to determine how far the cancer has spread. This is called "staging" and may involve:

• imaging tests, such as x-rays or CT scans
• Gallium scan or PET scan
• bone marrow test

Treatment of Lymphoma

Treatment plans weigh heavily on the type of lymphoma and the stage. There are four standard methods of lymphoma treatment:

• chemotherapy
• radiation therapy
• biologic therapy
• stem cell transplant/bone marrow transplant

Treatment of non-Hodgkin's lymphoma usually includes chemotherapy and radiation therapy. In some cases, a combination of both are used to treat the disease.

Hodgkin's lymphoma treatment varies among the more than twenty types of the disease. Chemotherapy is the standard treatment for most types, but other types of treatment may also be needed.

Lymphoma Prevention

While there are certain recognized risk factors for developing lymphoma, the cause for both Hodgkin's and Non-Hodgkin's lymphomas has yet to be determined. Research indicates that many patients diagnosed with lymphoma do not have any increased lymphoma risk factors used to determine the cause of the disease. Since it is not yet known what causes lymphoma, there is no general way to prevent it. Avoiding the lymphoma risk factors, such as smoking, can be helpful in reducing your risk of the disease. There are some risk factors, such as family history or age, which cannot be avoided. Keep in mind that just because you have a risk factor for lymphoma, this does not a guarantee that you will develop it. It only means you have an increased chance of developing lymphoma.