Our immune system comprises many types of cells, like lymphocytes, which include T cells and B cells. Their primary role is to fight infections and prevent diseases. In this process, B cells get converted into white blood plasma cells. The plasma cells are mainly found in the bone marrow and make antibodies called immunoglobins. Multiple myeloma begins in the plasma cells, where these cells become cancerous and begin to divide and grow uncontrollably. 

Impact of multiple myeloma
A single defective plasma cell typically leads to multiple myeloma. It then divides over many years and months, increasing the number of myeloma cells. During cell division, the myeloma cells could enter the bloodstream, reach other bone marrow, and continue damaging the plasma cells. As myeloma begins to develop in multiple bone marrow sites, cancer thus formed is called multiple myeloma.

The myeloma cells accumulate in the bone marrow, crowding the healthy cells. Instead of producing antibodies, the plasma cells produce abnormal proteins, leading to severe health complications. Multiple myeloma also can cause anemia and reduce platelet levels. Platelets are crucial for the blood to clot quickly. A person with multiple myeloma may suffer from frequent bruises and injuries due to a low platelet count. 

The body keeps remaking bone cells regularly to keep them strong. Myeloma interferes with this process, and our body can lose the ability to produce new bones. Thus, the old bones may weaken, increasing the risk of fractures. As the existing bones break down, the calcium level in one’s blood can also increase. Multiple myeloma also makes one’s body prone to infections as the immune system becomes weakened and incapable of fighting viruses and bacteria.  

Myeloma generally affects people between the ages of 65 and 70. Myeloma symptoms may not appear in the initial stages, and you may begin to notice visible symptoms only when the cancer is advanced. Hence, watching out for any abnormal symptoms and consulting a doctor becomes crucial to begin treatment immediately. Some of the most common signs of multiple myeloma are discussed below.

Bone pain
Multiple myeloma begins in the bone marrow and cortical bone. It causes the bone to become thin and also damages the bones. If it affects the bones in the spine, they may press on your spinal cord, causing severe pain. Mild, moderate, or severe bone pain is common in the middle and lower back, the hips, the ribs, and sometimes in the skull. The severity of the pain depends on the size of the damage and how quickly cancer spreads. The bone pain could intensify when they move. The pain may become sharper at night, making sleeping difficult. 

Fractures
Our body creates new bones and reabsorbs old bones to create a healthy balance between old and new bones. Osteoclast is the process of breaking down old bones, and osteoblast is the process of making new bones. Myeloma cells produce cytokines that trigger osteoclasts which destroy the nearby bones. The cytokines also interfere with osteoblasts and stop new bone formation. Consequently, the bones become thin and weak, or holes may begin forming in the bones. These directly lead to loss of bone strength and density, putting patients at high risk of fractures. Frequent fractures can be an important symptom of multiple myeloma.

Nerve damage and compression
If the bones around the spinal cord are affected by myeloma cells, spinal cord compression leads to severe pain. Besides pain, one may also experience numbness and muscle weakness, mainly in the legs. It is a symptom that you cannot ignore. Without immediate treatment, spinal cord compression can lead to paralysis. Myeloma cells produce abnormal proteins that can cause cramps, weakness, numbness, and frequent “pins and needles” sensations. If you often experience such sensations, do not ignore them and consult a doctor immediately for further testing and diagnosis. 

Frequent infections
The crowding of the myeloma cells in the bone marrow results in the reduction of normal red and white blood cells and platelets, all of which are crucial components of our immune system. It weakens the immune system and leads to frequent and unexplained infections. Frequent bouts of sinusitis, pneumonia, and infections in the kidney, bladder, and skin, are other symptoms of multiple myeloma. 

Fatigue
Myeloma cells crowd out the red blood cells from the bone marrow and inhibit their production leading to anemia. Red blood cells transport the oxygen necessary for our body. Without an adequate supply of oxygen, the immediate consequence of anemia is fatigue and exhaustion without apparent exertion. 

Hypercalcemia
The normal range of calcium in our blood is between 8.5 to 10.2 mg/dL (the amount may vary based on laboratories and their standard measurements). Calcium is crucial for bone health, dental health, and blood clotting. It is also vital for normal heart rhythm and helps muscles expand and contract. Low calcium levels in our blood are hypocalcemia, while higher calcium levels than usual characterize hypercalcemia. Multiple myeloma may lead to faster degeneration of bones which mixes with the bloodstream. Our kidneys may be unable to flush out all the calcium through urine, and the remaining calcium may mix with the blood leading to hypercalcemia. Some of the common and visible symptoms of hypercalcemia are:

• Dry mouth
•  Increased thirst
• Frequent urination
• Fatigue
• Sudden and unplanned body mass loss
• Frequent bladder and skin infections
• Confusion

The abnormal proteins produced by the myeloma cells may cause the blood to become thicker than usual, slowing down blood flow to the brain. It can cause dizziness and confusion. Some may experience difficulty speaking or weakness on one side of their body. The symptoms may look similar to a stroke; these are emergencies and, therefore, demands urgent medical attention.

Kidney-related problems
Kidney-related problems appear only when the cancer is advanced. With this condition, the kidney may not function normally and cannot flush out all the excess minerals and salts from the blood. One may experience swelling in the legs and ankles, weakness, breathing difficulties, and sudden or relentless itching.