Pituitary Tumor

Treatment and Diagnosis:

Doctors sometimes find multiple myeloma after a routine blood test. More often, doctors suspect multiple myeloma after an x-ray for a broken bone. Usually though, patients go to the doctor because they are having other symptoms.

To find out whether such problems are from multiple myeloma or some other condition, your doctor may ask about your personal and family medical history and do a physical exam. In addition, your doctor may order some of the following tests and exams:

• Blood tests: The lab checks the level of blood cells and other substances. Myeloma causes a high level of plasma cells and calcium. Most people with myeloma have anemia. Myeloma also causes high levels of certain proteins. The lab checks for M protein, beta-2-microglobulin, and other proteins.
• Urine tests: The lab checks for Bence Jones protein, a type of M protein, in urine. The lab measures the amount of Bence Jones protein in urine collected over a 24-hour period.

If the lab finds a high level of Bence Jones protein in your urine sample, doctors will monitor your kidneys. Bence Jones protein can clog the kidneys and damage them.

• X-rays: You may have x-rays to check for broken or thinning bones.
• Biopsy: The doctor removes tissue to look for cancer cells. A biopsy is the only sure way to know whether myeloma cells are in the bone marrow. The doctor removes some bone marrow from your hipbone or another large bone. Local anesthesia helps reduce the discomfort. A pathologist uses a microscope to check the tissue for cancer cells.

There are two ways the doctor can obtain bone marrow:

• Bone marrow aspiration: The doctor uses a thin needle to remove samples of bone marrow.
• Bone marrow biopsy: The doctor uses a thick needle to remove a small piece of bone and bone marrow.

Staging

If the biopsy shows that you have multiple myeloma, your doctor needs to know the extent (stage) of the disease to plan the best treatment. Staging may involve having more tests. You may have blood tests (including beta-2-microglobulin), CT scans, or an MRI of your bones.

Doctors may describe the disease as Stage I, Stage II, or Stage III. Higher numbers mean that a larger number of myeloma cells are in the body. The stage also takes into account whether the cancer is causing problems with your bones or kidneys.

Treatment

• Getting a Second Opinion
• Methods of Treatment
• Anticancer Drug Therapy
• Stem Cell Transplantation

Radiation Therapy

Many people with multiple myeloma want to take an active part in making decisions about their medical care. It is natural to want to learn all you can about your disease and your treatment choices. However, shock and stress after the diagnosis can make it hard to think of everything you want to ask the doctor. It often helps to make a list of questions before an appointment.

To help remember what the doctor says, you may take notes or ask whether you may use a tape recorder. You may also want to have a family member or friend with you when you talk to the doctor - to take part in the discussion, to take notes, or just to listen.

You do not need to ask all your questions at once. You will have other chances to ask your doctor to explain things that are not clear and to ask for more information.

Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat multiple myeloma include medical oncologists, radiation oncologists, and hematologists.

Getting a Second Opinion

Before starting treatment, you might want a second opinion about the diagnosis and treatment plan. Many insurance companies cover a second opinion if you or your doctor requests it. It may take some time and effort to gather medical records and arrange to see another doctor. Usually it is not a problem to take several weeks to get a second opinion. In most cases, the delay in starting treatment will not make treatment less effective. To make sure, you should discuss this delay with your doctor. Some people with multiple myeloma need treatment right away.

There are a number of ways to find a doctor for a second opinion:

• Your doctor may refer you to one or more specialists. At cancer centers, several specialists often work together as a team.

A local or state medical society, a nearby hospital, or a medical school can usually provide the names of specialists in your area.

Methods of Treatment

The choice of treatment depends mainly on the stage and symptoms of your disease. If you have multiple myeloma without symptoms, you may not need treatment for the cancer. The doctor monitors your health closely so that treatment can start when you begin to have symptoms.

If you have symptoms, your treatment will probably involve anticancer drugs (including steroids). Sometimes stem cell transplantation or radiation therapy is part of the treatment plan. Your doctor can describe your treatment choices and the expected results of each. You and your doctor can work together to develop a treatment plan that meets your needs.

Because standard treatment may not control myeloma, you may want to talk to your doctor about taking part in a clinical trial. Clinical trials are research studies of new treatment methods.

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At any stage of disease, you may receive supportive care to control health problems (such as infections) caused by multiple myeloma.

Anticancer Drug Therapy

Treatment of myeloma usually involves anticancer drugs. This treatment is called systemic therapy because the drugs enter the bloodstream and can affect myeloma cells all over the body.

Many different types of drugs are used to treat myeloma. Each type kills cancer cells in a different way.

Types of chemotherapy in common use include melphalan, cyclophosphamide, vincristine, and doxorubicin. Prednisone is a steroid that is often used. In some cases, the doctor may suggest new options, such as thalidomide and bortezomib. People often receive a combination of drugs.

You may receive the drugs by mouth or through a vein. The treatment usually takes place in an outpatient part of the hospital, at your doctor's office, or at home. Patients rarely need to stay in the hospital during treatment.

Stem Cell Transplantation

Some people with multiple myeloma have stem cell transplantation. A stem cell transplant allows a person to receive high doses of chemotherapy, radiation therapy, or both. The high doses destroy both myeloma cells and normal blood cells in the bone marrow. Later, the patient receives healthy stem cells through a flexible tube placed in a large vein in the neck or chest area. New blood cells develop from the transplanted stem cells.

Stem cell transplants take place in the hospital. Some patients have two or more transplants.

Stem cells may come from the patient or from a donor:

• Autologous stem cell transplantation: This type of transplant uses the patient's own stem cells. The stem cells are removed from the patient, and the cells may be treated to kill myeloma cells that may be present. The stem cells are frozen and stored. After the patient receives high-dose treatment, the stored stem cells are thawed and returned to the patient.
• Allogeneic stem cell transplantation: Sometimes healthy stem cells from a donor are available. The patient's brother, sister, or parent may be the donor. Or the stem cells may come from an unrelated donor. Doctors use blood tests to be sure the donor's cells match the patient's cells.

Syngeneic stem cell transplantation: This type of transplant uses stem cells from the patient's healthy identical twin.

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Radiation Therapy

Radiation therapy (also called radiotherapy) uses high-energy rays to kill myeloma cells and to help control pain. People receive radiation therapy at a hospital or clinic.

Radiation therapy is given two ways for people with myeloma:

• Local radiation: A large machine aims radiation at the bone or the part of the body where myeloma cells have collected. It is local therapy because it affects cells only in the treated area. This is the main treatment for people with a single plasmacytoma. People receive radiation for 4 to 5 weeks. A shorter course of radiation therapy can be used to control the growth of tumors in bones and help relieve pain.
• Total-body irradiation: Some patients receive radiation to their whole body before stem cell transplantation. The radiation treatments may be given 2 to 3 times a day for several days.

• Side Effects of Treatment
• Anticancer Drug Therapy
• Stem Cell Transplantation

Radiation Therapy

Because cancer treatment often damages healthy cells and tissues, unwanted side effects are common. Side effects depend mainly on the type and extent of the treatment. Side effects may not be the same for each person, and they may change from one treatment session to the next. Before treatment starts, your health care team will explain possible side effects and suggest ways to help you manage them.

Anticancer Drug Therapy

The side effects of anticancer drugs depend mainly on the specific drugs and the dose. The drugs affect cancer cells and other cells that divide rapidly:

• Blood cells: When drugs affect your healthy blood cells, you are more likely to get infections, bruise or bleed easily, and feel very weak and tired.
• Cells in hair roots: Anticancer drugs can cause you to lose your hair. The hair will grow back, but it may be somewhat different in color and texture.
• Cells that line the digestive tract: Anticancer drugs can cause poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores.

The drugs used for myeloma also may cause skin rash, blisters, cramps, blurred vision, lung problems, headache, dizziness, drowsiness, numbness or tingling in hands or feet, and blood clots.

Your doctor can suggest ways to control many of these side effects.

Stem Cell Transplantation

People who have stem cell transplantation face an increased risk of infection, bleeding, and other side effects because of the large doses of chemotherapy or radiation they receive. In addition, graft-versus-host disease (GVHD) may occur in people who receive stem cells from a donor. In GVHD, the donated stem cells react against the patient's tissues. Most often, GVHD affects the liver, skin, or digestive tract. GVHD can be serious. It can occur any time after the transplant, even years later. Steroids or other drugs may help treat or control GVHD.

Radiation Therapy

The side effects of radiation therapy depend mainly on the dose of radiation and the part of the body that is treated. For example, your skin in the treated area may become red, dry, and tender. You also may lose your hair in the treated area.

You are likely to become very tired during radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay as active as they can.

Although the side effects of radiation therapy can be distressing, your doctor can usually relieve them

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