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Macmillan and Cancerbackup merged in 2008. Together we provide free, high quality information for people affected by cancer through our publications, website and phone service. Find out more| .
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There are several ways of easing the symptoms of myeloma, so it is important to let your doctor know if you are having any problems.
Radiotherapy| may be used in a variety of ways. It uses high-energy x-rays, which destroy the myeloma cells while doing as little harm as possible to normal cells.
Radiotherapy is usually given by a machine, similar to an x-ray machine, that produces a beam of rays. The rays can be directed at specific bones where the myeloma cells have created a weak area. This treatment can be very effective at relieving the pain in bones weakened by myeloma and allowing the bones to repair themselves. You may only need one or two treatments. Your pain should reduce within 2–3 weeks.
In advanced myeloma, if chemotherapy| is no longer being effective, radiotherapy can be given to the whole body, half at a time, in two sessions several weeks apart. This, known as hemi-body irradiation, may help to reduce symptoms and control the disease for some time.
Radiotherapy may also sometimes be used as part of the preparation for a stem cell transplant|.
Radiotherapy is given in the hospital radiotherapy department. How the treatment is given can vary a lot, depending on your particular needs. If you only need one or two treatments, you may not need a lengthy first appointment to plan the treatment. If you are having a longer course of treatment you will need to go to the hospital before your treatment starts so that the area to be treated, and the dose to be given, can be accurately worked out. Normally a course of treatment is given daily for two to four weeks, from Monday to Friday, with a rest at the weekend.
Radiotherapy for myeloma only occasionally causes side effects such as nausea and vomiting|. If these do occur they can easily be treated – just let your doctor or nurse know. Any side effects should disappear once your course of treatment is over, but tell your doctor if they continue.
Radiotherapy can make you feel very tired|, so try to get as much rest as you can, especially if you have to travel a long way each day for your treatment.
A shortage of red blood cells (anaemia) is common in people with myeloma and may be due to several causes. Anaemia may make you feel tired and breathless|. It is quite common to have anaemia when myeloma is diagnosed but this will normally get better when treatment begins to control the myeloma.
Sometimes anaemia can develop because of the chemotherapy itself. If this happens your doctor may suggest that you have a blood transfusion|. The blood will be given to you through your central line| or PICC line|, if you have one, or into a vein in your arm.
At the first sign of any infection| or fever it is important to contact your doctor immediately so that they can prescribe antibiotics to help your body fight the infection. It will also help if you rest and drink plenty of fluids.
Radiotherapy and chemotherapy can help to reduce pain|, but let your doctor know if it is becoming troublesome while you are waiting for these treatments to take effect, .They can prescribe effective painkillers| to relieve your pain. You can try different types until you find one that works best for you. Our section, controlling cancer pain|, gives information about the different methods of pain control. Painkillers often work better if you take them regularly, rather than waiting for the pain to come back before taking them. Many painkillers can cause constipation, so make sure you eat a diet high in fibre and drink plenty of fluids. Your doctor can prescribe a laxative with your painkillers to prevent constipation| if this is needed. Gentle exercise can also help.
The myeloma cells in the bones can sometimes start to break down some of the bone cells, which release calcium into the blood. This condition is called hypercalcaemia and can cause symptoms such as tiredness, nausea, constipation, thirst, irritability and confusion. However, in some people hypercalcaemia is discovered during a blood test before any symptoms develop.
Your doctor may ask you to start drinking plenty of water and will put a drip of fluids into a vein in your arm (intravenous infusion). This will encourage the kidneys to extract the calcium and flush it from the body in your urine.
You may also be given a drug known as a bisphosphonate|, to reduce the calcium levels in your blood. Bisphosphonates prevent damage to the bone and will quickly reduce high calcium levels. The drug is given into a vein over a few hours and brings the calcium level down over the next 2–3 days. You may need a further dose if your calcium level starts to rise again.
Bisphosphonates are also available as tablets. These are not as effective as injections but they may help to increase the effect of the injections if necessary.
Surgery| is sometimes needed to repair a bone in the back, arm or leg that has been damaged or weakened by the myeloma cells. The operation will be done under a general anaesthetic and the damaged bone is strengthened with a metal pin or plate, which, once in place, cannot be felt or seen.
If the operation is on a limb, you will be able to start gently using it again the day after the operation, with the help of your physiotherapist. If the operation is on your back, you may need to rest for a few days before you start to move around again. You may also need some radiotherapy to the broken or weakened bone to destroy the myeloma cells in this bone and help it to heal.
If the bones of the spine (vertebrae) are weakened by the myeloma, they may collapse (known as a compression fracture). This can cause problems of pain, difficulty moving around and loss of height. This is often treated with painkillers, bed rest and by wearing a spinal brace.
Percutaneous vertebroplasty It may be possible to repair the compression fracture by injecting a special cement into the vertebrae which can help to stabilise the bone and relieve pain. This will only be carried out in specialist centres. Side effects are uncommon but possible effects include infection or damage to the nerves in the spine.
Balloon kyphoplasty This is a second technique that may be used to improve the strength of the bones of the spine, which may relieve pain and help people move around more easily. It involves inserting a balloon-like device, called an inflatable bone tamp, into the vertebrae and then slowly inflating it. Once the bone returns to its normal height, it can be injected with bone cement (as above). This is a newer technique, which will only be carried out in specialist centres. Possible side effects are similar to those caused by a percutaneous vertebroplasty. The long-term risks and benefits are not known.
Your doctor or specialist nurse will explain more about percutaneous vertebroplasty or balloon kyphoplasty if they feel that either treatment is appropriate for you.
Bisphosphonates are also sometimes used over a long period of time to help strengthen weakened areas of bone and prevent fractures and pain.
If your doctor prescribes bisphosphonates as tablets, you will take them every day. You and your doctor may find it more convenient for you to be given the drug into a vein once a month, particularly if this fits in with your trip to the hospital for chemotherapy.
Bisphosphonates usually cause few side effects but some people have indigestion, feel sick or are sick. If you develop these problems, discuss them with your doctor.
If you are working and your job involves heavy lifting, or if you take part in any sports that may put a strain on your back, you should ask your doctor's advice before going back to these activities.
Myeloma can develop in the bones of the spine. Sometimes in this situation, the tumour can cause pressure on the spinal cord. The bone may become weakened and put pressure on the cord. This is called spinal cord compression| and causes symptoms such as pain and tingling down the legs, weakness of the legs, or problems with passing urine or opening the bowels.
If you have any of these symptoms, you should let your doctor know as soon as possible. Spinal cord compression is usually treated with radiotherapy. Steroids| are also given to help reduce the pressure on the spinal cord. Early treatment is very important for spinal cord compression to prevent paralysis of the legs. Sometimes surgery is needed to repair or remove the affected bone.
The myeloma proteins may prevent your kidneys from filtering waste products from your blood properly, so it is essential to drink plenty of fluids each day – three litres or more if you can. This will help to flush your kidneys, allowing them to work more efficiently. If kidney damage is severe, the kidneys can stop working altogether. In kidney failure, no urine is produced and excess fluid begins to build up in the body. If this happens, you will be given kidney dialysis to artificially filter your blood. There are different ways of giving dialysis. You can contact our cancer support specialists| if you would like to discuss this treatment.
Rarely, if myeloma makes the level of paraproteins in the blood very high, the blood can become thicker than normal. This can cause symptoms such as headaches, dizziness, sight problems and abnormal bleeding. To help correct this problem it is sometimes possible to have plasma exchange| (plasmapheresis), a procedure which removes the excess paraproteins from the blood.
Our controlling the symptoms of cancer| section may be helpful.
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