Multiple myeloma history and symptoms: Difference between revisions

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{{Multiple myeloma}}
{{Multiple myeloma}}
{{CMG}} {{AE}}{{HL}}
{{CMG}} {{AE}} {{HMHJ}}; {{HL}}; {{shyam}}


==Overview==
==Overview==
The history and symptoms of [[multiple myeloma]] are based on the underlying effect of excess [[plasma cells]] on various [[Organ (anatomy)|organ]] systems. Pain is usually a symptom of newly diagnosed [[multiple myeloma]]. Broad categories of [[Symptom|symptoms]] include bone-related [[Symptom|symptoms]], [[neurological]] [[Symptom|symptoms]], [[hypercalcemia]]-related [[symptoms]], [[bone marrow failure]]-related [[symptoms]], and [[thrombosis]]-related [[Symptom|symptoms]]. Although all of these [[symptoms]] are possible, the presentation of [[multiple myeloma]] varies from [[patient]] to [[patient]].


The most common symptoms of multiple myeloma include [[bone pain]], [[pallor]], and [[fatigue]].<ref>Multiple myeloma. Wikipedia (2015) https://en.wikipedia.org/wiki/Multiple_myeloma#Signs_and_symptoms Accessed on September, 20th 2015</ref><ref>Multiple myeloma. Canadian Cancer Society (2015) http://www.cancer.ca/en/cancer-information/cancer-type/multiple-myeloma/signs-and-symptoms/?region=mb Accessed on September 20th 2015</ref><ref>Multiple myeloma. Cancer. gov(2015) http://www.cancer.gov/types/myeloma Accessed on September, 20th 2015</ref> However, the presenting symptoms of multiple myeloma may vary greatly due to involvement of many organ systems. The common symptoms of multiple myeloma can be remembered by the [[mnemonic]] ''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><ref>Multiple myeloma. Canadian Cancer Society (2015) http://www.cancer.ca/en/cancer-information/cancer-type/multiple-myeloma/signs-and-symptoms/?region=mb Accessed on September 20th 2015</ref><ref>Multiple myeloma. Cancer. gov(2015) http://www.cancer.gov/types/myeloma Accessed on September, 20th 2015</ref>
==History and Symptoms==
Relevant history includes:
*Review of past medical history for other [[plasma cell]] diseases, [[hematologic]] [[malignancies]], underlying [[Kidney|renal]] [[disease]], and underlying [[bone]] [[disease]]
*Review of [[family]] history for members with positive history of [[hematologic]] [[malignancies]]
*Review of occupational history related to farming, oil industry, or [[Agent Orange]] exposure


==History==
History includes character, location, onset, and duration of [[pain]] (typically [[Bone pain|bony pain]]). Symptoms of [[multiple myeloma]] include:<ref name="wiki">Multiple myeloma. Wikipedia (2015) https://en.wikipedia.org/wiki/Multiple_myeloma#Signs_and_symptoms Accessed on September, 20th 2015</ref><ref name="canada">Multiple myeloma. Canadian Cancer Society (2015) http://www.cancer.ca/en/cancer-information/cancer-type/multiple-myeloma/signs-and-symptoms/?region=mb Accessed on September 20th 2015</ref><ref name="gov">Multiple myeloma. Cancer. gov(2015) http://www.cancer.gov/types/myeloma Accessed on September, 20th 2015</ref><ref name="pmid24614435">{{cite journal |vauthors=Reisenbuckler C |title=Multiple myeloma and diagnostic imaging |journal=Radiol Technol |volume=85 |issue=4 |pages=391–410; quiz 411–3 |date=2014 |pmid=24614435 |doi= |url=}}</ref><ref name="pmid26294217">{{cite journal |vauthors=Sergentanis TN, Zagouri F, Tsilimidos G, Tsagianni A, Tseliou M, Dimopoulos MA, Psaltopoulou T |title=Risk Factors for Multiple Myeloma: A Systematic Review of Meta-Analyses |journal=Clin Lymphoma Myeloma Leuk |volume=15 |issue=10 |pages=563–77.e1–3 |date=October 2015 |pmid=26294217 |doi=10.1016/j.clml.2015.06.003 |url=}}</ref><ref name="pmid24130968">{{cite journal |vauthors=Eslick R, Talaulikar D |title=Multiple myeloma: from diagnosis to treatment |journal=Aust Fam Physician |volume=42 |issue=10 |pages=684–8 |date=October 2013 |pmid=24130968 |doi= |url=}}</ref>
* When evaluating a patient for multiple myeloma, you should take a detailed history of the presenting symptom (duration, onset, progression), other associated symptoms, and a thorough medication review. Other specific areas of focus when obtaining the history are outlined below:<ref>Multiple myeloma. MedlinePlus (2015)http://www.wikidoc.org/index.php?title=Multiple_myeloma_risk_factors&action=edit&section=2 Accessed on Septmeber, 20th 2015 </ref>
**Review past medical history for other [[plasma cell]] diseases
**Review family history for members with positive history of the disease
**Review occupational history related to farming or oil industry
**Review any exposure to [[radiation]] or toxic chemicals


==Common Symptoms==
:*[[Bone pain]]
Symptoms of multiple myeloma include:<ref>Multiple myeloma. Wikipedia (2015) https://en.wikipedia.org/wiki/Multiple_myeloma#Signs_and_symptoms Accessed on September, 20th 2015</ref><ref>Multiple myeloma. Canadian Cancer Society (2015) http://www.cancer.ca/en/cancer-information/cancer-type/multiple-myeloma/signs-and-symptoms/?region=mb Accessed on September 20th 2015</ref><ref>Multiple myeloma. Cancer. gov(2015) http://www.cancer.gov/types/myeloma Accessed on September, 20th 2015</ref>
::*Usually involves the [[spine]] and [[ribs]] ([[axial skeleton]]), and worsens with activity
::*Persistent localized [[pain]] may indicate a pathological [[bone fracture]]
::*Inability to carry out routine tasks due to limitation by [[pain]]


:*[[Bone pain]]
::*Usually involves the spine and ribs, and worsens with activity.
::*Persistent localized pain may indicate a pathological [[bone fracture]]
:*Neurological symptoms
:*Neurological symptoms
::*[[Numbness]]
::*[[Numbness]] due to [[plasma cell]] infiltration of [[nerves]] or anti-neuronal glycoprotein antibodies
::*[[Muscle weakness]]
::*[[Muscle weakness]]
::*[[Confusion]]
::*[[Confusion]]
Line 27: Line 26:
::*[[Headache]]
::*[[Headache]]
::*[[Paralysis]]
::*[[Paralysis]]
::*Visual changes
::*[[Visual]] changes
:*[[Hypercalcemia]] related symptoms
 
::*[[Polyurea]]
:*[[Hypercalcemia]]-related symptoms
::*[[Polyuria]]
::*[[Polydipsia]]
::*[[Polydipsia]]
::*[[Constipation]]
::*[[Constipation]]
::*Loss of appetite
::*Loss of appetite
::*Weakness
::*[[Nausea and vomiting]]
::*[[Nausea]] and vomiting
::*[[Lethargy]] due to [[anemia]]
::*Lethargy
:*Bone marrow failure related symptoms
::*Easy bruising, nosebleeds, bleeding gums due to [[thrombocytopenia]]
::*Fatigue, weakness, shortness of breath, dizziness and paleness due to [[anemia]]  
::*Recurrent infections due to decreased white blood cell count.
:*Lower limb [[edema]] due to renal involvement


:*[[Bone marrow]] failure-related [[symptoms]]: This is due to crowding out of normal [[bone marrow]] precursors by [[malignant]] [[plasma cells]].
::*Easy [[bruising]], nosebleeds, bleeding [[gums]] due to [[thrombocytopenia]]
::*[[Fatigue]], weakness, shortness of breath, [[dizziness]] and paleness due to [[anemia]]
::*Recurrent [[infections]] due to [[leukopenia]]
:*Lower [[limb]] [[edema]] due to [[renal]] involvement
:*[[Thrombosis|Thrombotic]] symptoms: [[Thrombosis]] is more common in [[multiple myeloma]] due to [[cancer]]-associated [[thrombosis]] and due to [[lenalidomide]], which increases [[Thrombosis|thrombotic]] risk.
::*Shortness of breath due to [[pulmonary embolism]]
::*Lower [[Limb|extremity]] [[edema]] due to [[deep vein thrombosis]]
::*Abdominal pain due to mesenteric venous thrombosis
::*[[Transient ischemic attack]]
::*[[Retinal]] [[hemorrhage]]
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


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Latest revision as of 22:47, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Hannan Javed, M.D.[2]; Haytham Allaham, M.D. [3]; Shyam Patel [4]

Overview

The history and symptoms of multiple myeloma are based on the underlying effect of excess plasma cells on various organ systems. Pain is usually a symptom of newly diagnosed multiple myeloma. Broad categories of symptoms include bone-related symptoms, neurological symptoms, hypercalcemia-related symptoms, bone marrow failure-related symptoms, and thrombosis-related symptoms. Although all of these symptoms are possible, the presentation of multiple myeloma varies from patient to patient.

History and Symptoms

Relevant history includes:

History includes character, location, onset, and duration of pain (typically bony pain). Symptoms of multiple myeloma include:[1][2][3][4][5][6]

  • Neurological symptoms

References

  1. Multiple myeloma. Wikipedia (2015) https://en.wikipedia.org/wiki/Multiple_myeloma#Signs_and_symptoms Accessed on September, 20th 2015
  2. Multiple myeloma. Canadian Cancer Society (2015) http://www.cancer.ca/en/cancer-information/cancer-type/multiple-myeloma/signs-and-symptoms/?region=mb Accessed on September 20th 2015
  3. Multiple myeloma. Cancer. gov(2015) http://www.cancer.gov/types/myeloma Accessed on September, 20th 2015
  4. Reisenbuckler C (2014). "Multiple myeloma and diagnostic imaging". Radiol Technol. 85 (4): 391–410, quiz 411–3. PMID 24614435.
  5. Sergentanis TN, Zagouri F, Tsilimidos G, Tsagianni A, Tseliou M, Dimopoulos MA, Psaltopoulou T (October 2015). "Risk Factors for Multiple Myeloma: A Systematic Review of Meta-Analyses". Clin Lymphoma Myeloma Leuk. 15 (10): 563–77.e1–3. doi:10.1016/j.clml.2015.06.003. PMID 26294217.
  6. Eslick R, Talaulikar D (October 2013). "Multiple myeloma: from diagnosis to treatment". Aust Fam Physician. 42 (10): 684–8. PMID 24130968.