Myeloma

Also called Multiple myeloma

The cancer most often diagnosed late, because back pain and tiredness in an older person get explained away. Ask for the blood test by name.

What it is

A cancer of plasma cells in the bone marrow. It causes bone damage, anaemia, kidney damage and a raised calcium level, and it is treatable but not usually curable.

It has the longest diagnostic delay of any common cancer in the UK. The reason is that its symptoms are the symptoms of being older and tired: back pain, fatigue, and repeated infections. Somebody in their seventies with back pain does not get a myeloma screen; they get painkillers and physiotherapy.

The tests are simple, cheap and available in every practice: a full blood count, kidney function, calcium, and a specific test for the abnormal protein myeloma produces. Asking for them by name is often what changes the timeline.

Bone damage causes fractures in bones that should not break, and spinal collapse that can compress the spinal cord. That is an emergency and needs to be recognised.

Many people are found to have a symptomless precursor condition, MGUS, on a routine blood test. Most never develop myeloma, and monitoring is the appropriate response.

Signs you might notice

Persistent back, rib or hip pain, particularly bone pain that is worse at night or at rest and does not behave like a muscular problem.

Fatigue and breathlessness from anaemia.

Repeated infections, particularly chest infections.

A fracture from a minor injury, or no injury at all.

Thirst, constipation, confusion and drowsiness, which can mean a high calcium level and needs same-day assessment.

Kidney problems found on a blood test with no obvious cause.

Emergency: severe back pain with leg weakness, numbness in the saddle area, or loss of bladder or bowel control. This is spinal cord compression or cauda equina syndrome and needs A and E the same day.

How it can affect day-to-day life

Bone pain and the fear of fracture shape everything: how somebody lifts, bends, gets out of a chair, whether they go out.

Treatment is a long series of cycles, remissions and relapses rather than a single course, and people describe living with a condition rather than beating one. That rhythm is exhausting in a particular way.

Fatigue, neuropathy from treatment, and steroid effects on mood and sleep are the three things people most often say nobody warned them about.

Infection risk is raised throughout, so vaccinations and prompt treatment of infections matter more than usual.

Kidney function needs protecting: hydration, and care with anti-inflammatory painkillers, which are commonly taken for the very back pain that myeloma is causing.

Supporting someone well

For persistent unexplained back pain in an adult over 50, particularly with tiredness or repeated infections, ask the GP directly for a myeloma screen: full blood count, calcium, kidney function, and serum protein electrophoresis.

Learn the spinal cord compression warning signs and treat them as an emergency.

Avoid anti-inflammatory painkillers unless the team has approved them; they can damage already-vulnerable kidneys.

Keep fluids up.

Ask about bone-protecting treatment, which is standard and sometimes missed.

Keep vaccinations up to date, and get infections seen early.

Ask for the clinical nurse specialist and for early involvement of a pain specialist. Bone pain in myeloma responds to specific treatment, including radiotherapy.

Where to get help

A GP practice, asking for the blood tests by name.

A and E for back pain with leg weakness, numbness in the saddle area, or continence changes.

Myeloma UK run an infoline on 0800 980 3332 and are the specialist charity.

Blood Cancer UK on 0808 2080 888.