Multiple myeloma (a rare blood cancer) is often treated with many lines of medications (usually starting with "Induction Therapy" such as chemotherapy, immunotherapy, and stem cell transplants rather than traditional surgery.
However, there are cases where multiple myeloma surgery can be a valuable part of a patient's treatment plan. While there is no cure to multiple myeloma, it can help reach remission, which is where it may improve quality of life for people to the point of not needing treatment. This article will serve to explain the role of surgery in multiple myeloma.
Also, to preface, if you are interested in learning about other multiple myeloma patients stories about different surgeries, then join Patient Connect to learn about other peoples multiple myeloma stories.
What is Multiple Myeloma?
First, starting with the basics, multiple myeloma develops when plasma cells in the bone marrow begin to grow uncontrollably, producing abnormal proteins known as monoclonal proteins or M proteins. These proteins can build up in various organs, leading to complications such as kidney damage, bone lesions, and weakened immune function. Common symptoms include bone pain, frequent infections, fatigue, and anemia.
The primary treatments for multiple myeloma usually are chemotherapy, targeted therapies, stem cell transplants, and sometimes radiation. These therapies aim to slow or halt the progression of the disease, reduce symptoms, and improve the patient’s quality of life. However, in cases where multiple myeloma causes specific complications, surgery may be considered.
Why is Surgery Rarely Used in Multiple Myeloma?
Unlike solid tumors that can be surgically removed, multiple myeloma involves blood cells that spread throughout the bone marrow, making it challenging to target the cancerous cells with surgery alone. For this reason, multiple myeloma is primarily managed with systemic treatments, which target cancer cells throughout the body. Nevertheless, surgery can play a critical role in managing certain symptoms or complications.
Some of the main reasons surgery may be used in multiple myeloma include:
Relieving Pain from Bone Lesions
Preventing or Stabilizing Bone Fractures
Managing Spinal Cord Compression
Improving Function or Mobility
Surgical intervention is typically considered when non-surgical treatments such as medication or radiation fail to control symptoms effectively.
Types of Surgery for Multiple Myeloma
When surgery is deemed necessary for multiple myeloma, the procedure is usually focused on specific complications. Here are some of the primary types of multiple myeloma surgery and how they are used:
1. Kyphoplasty and Vertebroplasty
Kyphoplasty and vertebroplasty are minimally invasive procedures commonly used to address vertebral compression fractures, a common issue in multiple myeloma patients. These fractures occur when myeloma cells weaken the vertebrae, causing them to collapse. Both kyphoplasty and vertebroplasty aim to restore stability to the spine, reduce pain, and improve mobility.
Kyphoplasty involves inserting a small balloon into the compressed vertebra. The balloon is inflated to create space, and then the space is filled with bone cement to stabilize the structure.
Vertebroplasty is similar, but instead of using a balloon, bone cement is injected directly into the collapsed vertebra to strengthen it.
Both procedures are often performed under local anesthesia and have a relatively short recovery time, allowing patients to return to daily activities quickly.
2. Spinal Decompression Surgery
When multiple myeloma causes bone lesions or fractures in the spine, it can lead to spinal cord compression. This is a serious condition that can cause pain, weakness, and even paralysis if not treated promptly. In cases of spinal cord compression, a surgical procedure known as spinal decompression surgery may be recommended.
During spinal decompression surgery, the surgeon removes the part of the vertebra pressing on the spinal cord, relieving pressure and reducing pain. This procedure is more complex than kyphoplasty or vertebroplasty and may require a longer recovery period, but it is essential for preventing permanent nerve damage.
3. Orthopedic Surgery for Bone Fractures
Multiple myeloma often leads to osteolytic lesions, which are areas of weakened bone caused by the abnormal activity of cancerous plasma cells. These lesions can make bones more susceptible to fractures. When a major bone, such as the femur (thigh bone) or humerus (upper arm bone), is at risk of breaking or has already fractured, orthopedic surgery may be necessary.
Orthopedic surgery for multiple myeloma often involves the use of metal rods, plates, or screws to stabilize the affected bone. This stabilization helps reduce pain, improve mobility, and prevent further damage to the bone.
4. Biopsy and Diagnostic Procedures
In some cases, surgery is used to obtain tissue samples for diagnosis or to assess the extent of the disease. A bone marrow biopsy is a common procedure in multiple myeloma, where a small sample of bone marrow is extracted from the hip bone to analyze the presence and activity of myeloma cells. Though not a treatment, a biopsy is an essential part of diagnosing and staging multiple myeloma.
Risks and Considerations for Multiple Myeloma Surgery
As with any surgery, procedures for multiple myeloma come with potential risks and considerations. Since many multiple myeloma patients have weakened immune systems and fragile bones, surgical procedures can be challenging. Some key risks include:
Infection: Multiple myeloma can compromise the immune system, increasing the risk of infection after surgery. Doctors often take extra precautions to reduce this risk, including the use of antibiotics before and after surgery.
Delayed Healing: Due to bone damage from myeloma cells and certain treatments, bones may take longer to heal after surgery. This can be managed with physical therapy and close monitoring.
Blood Clotting Issues: Some multiple myeloma patients experience blood clotting issues, either due to the disease itself or certain medications. Doctors may need to monitor clotting factors and adjust medications accordingly before surgery.
Preparing for Multiple Myeloma Surgery
Preparation for multiple myeloma surgery typically involves a series of medical evaluations to ensure the patient is fit for surgery. Blood tests, imaging studies, and consultations with specialists such as oncologists, orthopedic surgeons, or neurosurgeons are common. Physical therapy may also be recommended before and after surgery to help maintain mobility and strength.
Patients should openly discuss any medications they are taking, as certain drugs used to manage multiple myeloma, such as anticoagulants, may need to be paused or adjusted to reduce bleeding risks. Additionally, it’s essential to have a clear plan for post-operative care, including follow-up visits, physical therapy, and potential adjustments to medication regimens.
Recovery and Post-Surgical Care
Recovery times vary depending on the type and extent of surgery performed. Minimally invasive procedures like kyphoplasty or vertebroplasty often require only a few days of recovery, while more complex surgeries, such as spinal decompression, may take several weeks to months for full recovery.
Post-operative care is crucial for achieving the best outcomes. Here are some key aspects of post-surgical care for multiple myeloma patients:
Pain Management: Pain can be managed with medications, including over-the-counter pain relievers and prescribed medications.
Physical Therapy: Regular physical therapy helps restore mobility, build strength, and prevent muscle atrophy.
Follow-Up Monitoring: Regular follow-up appointments are necessary to monitor healing and address any complications, such as infections or issues with surgical hardware.
Bone Health Management: Medications to strengthen bones, such as bisphosphonates, may be recommended to help reduce the risk of future fractures and improve overall bone health.
When to Consider Multiple Myeloma Surgery
Decisions about surgery should be made collaboratively between the patient and their healthcare team. Surgery is typically considered when other treatments have not adequately controlled symptoms or when structural damage threatens the patient's quality of life.
Signs that surgery may be beneficial include:
Persistent or worsening bone pain, especially in the spine
Difficulty with mobility or activities of daily living due to bone damage
Neurological symptoms, such as weakness or numbness, suggesting spinal cord compression
Outlook for Multiple Myeloma Patients Undergoing Surgery
While multiple myeloma surgery is not curative, it can significantly improve quality of life for patients facing complications from the disease. By addressing bone fractures, spinal compression, and other structural issues, surgery can relieve pain, enhance mobility, and allow patients to focus more on their overall health and treatment.
For those dealing with multiple myeloma, understanding the potential role of surgery is essential. Although surgery is less common in multiple myeloma treatment, it offers targeted relief for some of the disease’s most challenging symptoms, contributing to better outcomes when combined with other therapies.
Conclusion
While systemic treatments are the cornerstone of multiple myeloma care, surgery can be an invaluable tool in managing specific complications. Whether it’s stabilizing fractures, decompressing the spine, or relieving pain, multiple myeloma surgery plays a key role in improving patients’ lives. As always, it’s essential to discuss all options with your healthcare team and consider both the benefits and risks of surgery.
For more resources, support, and connections with other multiple myeloma patients, consider joining Patient Connect, an online community where patients share their experiences and knowledge to empower each other. By staying informed and engaged, you can make the most of your multiple myeloma journey and navigate each step with confidence.
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