Stages of This Blood Cancer

Usually when a patient comes into an oncologist's office, like mine, it says "cancer" on the door. So they know they have cancer, but they really don't know what to expect. So what you want to determine is, how serious is the multiple myeloma? How extensive is it? How is it affecting other organs?

There's a big spectrum with multiple myeloma and all these plasma cell problems, from something that we call monoclonal gammopathy of unclear significance, or MGUS, where you have just a few abnormal plasma cells making an abnormal antibody, all the way to a very aggressive myeloma that can be life-threatening.

Most cancers are staged from I, II, III, and IV, and it's very cut and dry. Stage I is a small tumor. Stage II is maybe a bigger tumor in the lymph nodes. Stage III means the cancer has spread into the lymph nodes or it's a more aggressive tumor. And stage IV means it's spread throughout the whole body. Multiple myeloma staging is completely different, because from the beginning, those plasma cells are basically in all the bones for most people, so it's already spread.

There is a staging system for myeloma that can classify between I, II, and III. For most people with myeloma, if they have a stage I myeloma, then that is going to be a lower-risk cancer they're going to be able to live with for a very long time. On the opposite end, for patients with a stage III myeloma, that's going to be a very aggressive cancer that's going to need very aggressive treatment if they're going to be able to get in remission and have a long time with a good quality of life.

A stage I multiple myeloma can often be treated simply with maybe one or two medications. A stage II is going to need combination of medications to treat, and you definitely want to be a little bit more aggressive about getting it under control and getting into remission and maybe moving towards a stem cell transplant. A stage III myeloma is -- that's a patient who's going to need a whole lot of supportive care, more aggressive chemotherapy to get into remission, and more likely to have all these other organ problems like fractures or kidney failure or need blood transfusions, or all the problems that a cancer can cause.

When I talk to my patients about multiple myeloma, I don't talk about stage at all. And most oncologists in practice don't talk about it because it really isn't very helpful for making decisions. What we do talk about is, we discuss how aggressive is your multiple myeloma in your case and in your situation. Because it also has to do with a patient's overall health. So you have to put the overall amount, the aggressiveness of the cancer, in the context of that individual person.

When I meet a patient with multiple myeloma, every one of them is in a different situation. So the conversation is completely different depending on the patient situation and all the other factors. So that determinant of the biology of what's really going on in the cancer cells and how sick is it making you, that kind of sets the course for how you're going to move forward and what to expect.