Symptoms and diagnosis of multiple myeloma

Symptoms of multiple myeloma

Reduced blood cell counts resulting in: 

• Anaemia (low haemoglobin, which can cause weakness and breathlessness)
• Bruising or bleeding (low platelet cells)
• Infections (low white cells/antibodies not working as well) 

Bone pain and fractures (broken bones) 

High calcium in the blood, which can cause: 

• Nausea
• Vomiting 
• Constipation 
• Confusion 
• Kidney problems 

The symptoms of multiple myeloma affect every patient differently. Symptoms depend on the extent and type of multiple myeloma. Symptoms may be vague at first or they may have a big effect on you. 

Symptoms can be caused by conditions other than cancer, but it’s important to go to the GP and get any unusual changes checked out. 

More about multiple myeloma symptoms

If you’ve already been diagnosed with myeloma, let your medical team know if you get any new symptoms. 

Bone effects

The most common symptoms of bone disease are: 

Bone pain 

Multiple myeloma cells can often destroy bone tissue. Soft spots’ or ‘holes’ may develop where the bone has been damaged. They can cause bone pain and swelling, particularly in your middle or lower back, ribcage and your hips. Often the pain is dull and aching but persistent. Sometimes moving can make it feel worse.

Bone fractures and reduced bone density 

Thinning of the bone and fractures (breaks) can happen in any bone where damage occurs due to multiple myeloma. These are caused by the disease rather than through an injury.

Numbness, pins and needles or weakness in your feet or legs

This may be a sign of spinal cord compression, where a multiple myeloma tumour presses on your spinal cord. 

Spinal cord compression is a medical emergency, so get medical help immmediately if you have myeloma and develop this symptom or if you lose control of your bladder or bowels.

Blood effects

The growing number of myeloma cells can affect production of blood cells in your bone marrow, as there may be little space for normal blood cells to develop. Lack of blood cells can cause symptoms. 

Fewer red blood cells

Fatigue and anaemia (low haemoglobin). You may also look pale and have shortness of breath and weakness, because less oxygen is carried in your blood. 

Fewer white blood cells

Risk of infection. This includes repeated coughs, colds and flus, and other infections, especially chest infections. It also may take longer to recover from any type of infection. 

Fewer platelets

Unexplained bruising or bleeding, such as nosebleeds or bleeding gums.

Kidney effects

The most common kidney problems include reduced kidney function and high blood calcium (hypercalcaemia).

Reduced kidney function 

• Less urine (pee) when you go to the toilet. This doesn’t always happen 
• Swelling in your legs, ankles or feet, caused by fluid retention 
• Shortness of breath 
• Fatigue (feeling very tired)

Kidney damage or sometimes kidney failure can be caused by abnormal proteins called 'light chains' produced by the myeloma cells. The light chains can block the tubes in the kidneys and stop them filtering waste products from your blood properly. 

Hypercalcaemia 

Hypercalcaemia is when there is too much calcium in your blood. It can cause:

•  Loss of appetite 
• Nausea (feeling sick) and vomiting
• Constipation and abdominal (tummy) pain
•  The need to drink more fluids and urinate (pee) more 
• Tiredness, weakness or muscle pain 
• Confusion, disorientation and difficulty thinking
• Headaches 
• Depression

When bone tissue is destroyed, it causes the level of calcium to rise in your bloodstream. This is called hypercalcaemia. Your kidneys can get overworked by trying to get rid of this excess calcium.  

Can I be screened for multiple myeloma?

Testing for multiple myeloma when you have no symptoms is called screening. There is no multiple myeloma screening programme. This is because there have been no tests proven to help predict this cancer.

If you are worried about myeloma, write down the symptoms you have noticed and whether you have any family history of myeloma and contact your family doctor (GP). 

Diagnosing multiple myeloma 

Your family doctor (GP) will talk to you about your symptoms and arrange blood tests, if needed. If your blood test is abnormal you will be referred to hospital for more tests, such as further blood and urine tests and scans.  Read more about tests for multiple myeloma.

CRAB-I: The assessment tool CRAB-I may be used when describing the effects of multiple myeloma: 

• Calcium in the blood - too much calcium in the blood
• Renal (kidney) damage
• Anaemia (lack of red blood cells) 
• Bone damage
• Infections