American Medical Association Family Medical Guide - American Medical Association [379]
Diagnosis
If your doctor suspects that you have multiple myeloma, he or she will recommend laboratory analysis of samples of your blood and urine and X-rays of your bones.
Treatment
In the early stage of multiple myeloma, no treatment is necessary if you don’t have any complications such as anemia. Because your resistance to infections is low, your doctor may prescribe antibiotics if you have any symptoms of infection. If the cancer has become more advanced and is causing symptoms, you will be given chemotherapy (see page 23) or drugs such as corticosteroids or thalidomide or newer derivatives of thalidomide, depending on your age and the stage of the cancer. Multiple myeloma cannot be cured with traditional chemotherapy but, in some cases, a stem cell transplant (see page 624) with cells donated by a sibling can significantly prolong survival and may cure the disease.
If you have had bone destruction, your doctor will prescribe a medication to repair bone tissue and prevent more bone destruction and pain. Fractures can often be prevented with surgery or radiation therapy (see page 23). If you have anemia, you will be given injections of a human protein called erythropoietin to increase your body’s production of red blood cells.
Polycythemia
Normally your body regulates the production of blood cells in the bone marrow, balancing the number of blood cells the marrow makes with the number of cells that die during natural body processes. If you have polycythemia, this regulation is faulty and the marrow produces far more blood cells than the body needs.
Polycythemia has two main forms—polycythemia vera and secondary polycythemia. Polycythemia vera, the more serious form, is an overproduction of red blood cells (which deliver oxygen to tissues), granulocytes (white blood cells that fight infections), and platelets (which enable blood to clot). Although polycythemia vera cannot be cured, it can be treated, and many people have relief from their symptoms for years at a time and live for many years. Possible complications of polycythemia vera include heart attack (see page 567), stroke (see page 669), deep vein thrombosis (see page 605), pulmonary embolism (see page 606), peripheral arterial thrombosis, bleeding, gout (see page 1004), and acute myelogenous leukemia (see page 621).
Unlike polycythemia vera, the secondary form of polycythemia is not triggered by a cancerous overproduction of cells. Secondary polycythemia is brought on by an underlying disorder such as severe lung disease or some kinds of congenital heart disease (see page 389), or by living at high altitudes or smoking, all of which can reduce the amount of oxygen supplied to tissues. In response to the signal that the tissues need more oxygen, the bone marrow produces more oxygen-delivering red blood cells. Secondary polycythemia can also develop as a result of noncancerous or cancerous tumors of the kidney, brain, or liver. To treat secondary polycythemia, a doctor diagnoses and treats the underlying disorder.
Symptoms
The most common symptoms of polycythemia vera include recurring headaches, dizziness, visual disturbances, a feeling of fullness in the head, and a ruddy complexion. You also may have severe itching that worsens when you take a hot bath. The condition can also cause enlargement of the spleen (an organ of the immune system that stores red blood cells and platelets), which a doctor can feel during a physical examination. Secondary polycythemia can cause headache, lethargy, and elevated blood pressure.
Diagnosis
To diagnose polycythemia,