Understanding your diagnosis
Your test results provide a lot of information about your myeloma.
This may include:
- the cells it started in (cancer type)
- whether it has spread from where it started (cancer stage)
- whether it is likely to grow quickly or slowly (cancer grade).
Your specialist uses this information to explain how the cancer could affect you in the future (your prognosis), and what your treatment options are. Your specialist may arrange further tests if more information is required.
What you need to know
Blood cells are formed through a process called haematopoiesis. This usually occurs in the bone marrow, which is a sponge-like tissue found inside many bones in the body. It may also occur in other tissues, like the spleen, liver, thymus (a gland behind the breastbone), and lymph nodes.
During this process, immature cells called haematopoietic stem cells develop into different types of blood cells.
The three main types of blood cells are:
- red blood cells
- white blood cells
Blood cancers start when a part of haematopoiesis goes wrong, and one or more cells become abnormal and start growing and dividing rapidly.
These immature abnormal blood cells crowd out normal blood cells in the bone marrow. They can also enter into the blood or lymphatic circulation and travel around the body.
The main types of blood cancer are:
Myeloma (multiple myeloma)
Myeloma is a cancer of plasma cells, which are a type of white blood cell.
Normal plasma cells produce immunoglobulins (Ig) which help the body fight infections. There are 5 different immunoglobulins called IgG, IgA, IgD, IgE and IgM.
In myeloma, the abnormal plasma cells:
- produce a single type of immunoglobulin which doesn’t work as it is supposed to – this is called a paraprotein or M-protein
- crowd out the bone marrow, reducing the production of normal blood cells and weakening the bone
- can group together and form a lump, called a plasmacytoma – these can be single (solitary) or multiple.
Myeloma is also known as multiple myeloma because it usually affects multiple areas of the body at the same time.
Types of myeloma
Myelomas are described by the type of immunoglobulin affected. These include:
- IgG – the most common type of myeloma
- IgA – the second most common type
- IgM, IgD and IgE – rare types of myeloma
- Light chain myeloma or Bence Jones protein (BJP) myeloma
- Plasma cell leukaemia – rare type of myeloma.
Other related conditions include:
- monoclonal gammopathy of undetermined significance (MGUS)
- smouldering myeloma
The stage of a cancer describes the amount of cancer in the body when it is first diagnosed, and whether it has spread from where it started.
Knowing the stage of a cancer helps doctors to work out the best treatment options. It also means the person with cancer can fully understand their situation and discuss any concerns they have.
There are several ways of staging or classifying myeloma.
Revised International Staging System (R-ISS)
This is the most common staging system for myeloma. It splits myeloma into 3 stages, based on the amount of certain proteins found in the blood, the blood levels of an enzyme called lactate dehydrogenase (LDH), and the results of cytogenetic testing of the bone marrow biopsy.
This is a way of classifying myeloma, which helps doctors to know when myeloma is active and when to start treatment. It is based on the person’s test results and symptoms.
C – increased blood calcium level
R – renal or kidney problems
A – anaemia
B – bone changes.
What to ask or talk about
Talking about prognosis
Prognosis means what is likely to happen to you in the future because of your cancer. You may find it hard to talk about prognosis but it can help you make decisions about the treatment and care you want.
Everyone’s cancer is different, and everyone responds differently to treatment. Because of this, doctors can’t tell you exactly what will happen to you. Instead, they can give you the best information they have about what to expect.
Doctors work out prognosis based on statistics. These show what happens in large groups of people with cancer. They cannot predict what will happen to you or any other individual person.
Your specialist will share information about you and your cancer with a multidisciplinary team (MDT) to decide the best treatment options for you.
You may need more than one type of treatment or have a choice of treatments. You may also need to see other specialists during treatment planning.
Dealing with your diagnosis
Getting a cancer diagnosis is very distressing for the person with cancer, and their carers, family and friends. Different people react in different ways. They can be upset and angry or just in shock. Many people find it difficult to take in all the information and understand what it will mean for them.
The situation can be especially difficult for people who get a diagnosis of advanced cancer.
If you need to speak to someone about your diagnosis, you can call the Cancer Council on 13 11 20.