REPUBLIC OF THE PHILIPPINES

CELLULAR ABERRATIONS NCM 113

SULTAN KUDARAT STATE UNIVERSITY | COLLEGE OF HEALTH AND SCIENCES

BRAIN AND NERVOUS SYSTEM CANCER PATHOPHYSIOLOGY

OVERVIEW
Brain and nervous system cancers refers to abnormal
growths of cells within the brain, spinal cord, and other
components of the nervous system. These growths
can be either benign (non-cancerous) or malignant
(cancerous). Malignant tumors are more serious
because they can invade nearby tissues and
potentially spread to other parts of the body.

Common types of brain and nervous system cancers

include gliomas (arising from glial cells),=
meningiomas (originating in the meninges), and
medulloblastomas (often found in the cerebellum, more
common in children).

Symptoms can vary widely depending on the location

and size of the tumor. They may include headaches,
seizures, changes in vision or speech, motor
coordination difficulties, and personality changes.

Diagnosis typically involves imaging studies like MRI or

CT scans, along with biopsies for confirmation. RISK FACTORS
Treatment options may include surgery, radiation
therapy, chemotherapy, targeted therapy, and • Radiation Exposure
immunotherapy. The choice of treatment depends on • Family History
factors such as the type, grade, and location of the • Age
tumor, as well as the patient's overall health. • Gender
• Certain Occupational Exposures
Early detection and treatment are crucial for better • Inherited Gene Mutations
outcomes. Multidisciplinary care teams, including • Exposure to Environmental Toxins
neurosurgeons, neuro-oncologists, and radiation • Viral Infections
oncologists, work together to provide the best possible • Previous Radiation Therapy to the Head
care for individuals with brain and nervous system • Previous Cancer History
cancers.
SIGN AND SYMPTOMS
EPIDEMIOLOGY
The symptoms of brain and nervous system
According to Brain tumor statistics. (2023, May 31).
Cancer of the nervous system is the 10th highest cancers can vary widely depending on the type,
cause of mortality in both men and women. In the location, and size of the tumor. Common
United States in 2023, it is anticipated that 18,990 symptoms of Brain and Nervous System Cancer
people would die (11,020 men and 7,970 women) from include:
primary malignant brain and CNS tumors.
• Headaches
Primary malignant brain and CNS tumors claimed the • Seizures
lives of an estimated 251,329 persons globally in 2020. • Neurological Deficits
According to the study of Orduña, P. C., & Lubaton- • Vision Changes
Sacro, C. A. (2022). Brain tumors were the second • Nausea and Vomiting
most prevalent malignancy in children aged 0-14 years • Personality or Behavioral Changes
old globally , with incidence ranging from 1.12- 5.14 • Cognitive Changes
cases per 100,000 people. The most prevalent tumors • Fatigue
in the Philippines were astrocytoma (25.8%), followed • Difficulty with daily activities
by medulloblastoma (23.9%). • Changes in bladder or bowel function

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SULTAN KUDARAT STATE UNIVERSITY | COLLEGE OF HEALTH AND SCIENCES

• The tumor comes from an overproduction of

Schwann cells—the cells that normally wrap
TYPES
around nerve fibers like onion skin to help support
• Gliomas and insulate nerves.
• Meningioma
• As the vestibular schwannoma grows, it affects
• Medulloblastoma
the hearing and balance nerves, usually causing
• Schwannoma (Vestibular Schwannoma)
unilateral (one-sided) or asymmetric hearing loss,
• Pituitary Adenoma
tinnitus (ringing in the ear), and dizziness/loss of
• Craniopharyngioma
balance.
• Chordoma
• Primary Central Nervous System PITUITARY ADENOMA
Lymphoma (PCNSL)
• A pituitary adenoma is a benign (noncancerous)
• Metastatic Brain Tumors
growth on your pituitary gland. Unlike cancer, it
• Astrocytoma
doesn’t spread to other parts of your body. But as
GLIOMAS MULTIFORME pituitary adenomas grow, they can put pressure
on nearby structures and cause symptoms.
• A fast-growing type of central nervous system
tumor that forms from glial (supportive) tissue of CRANIOPHARYNGIOMA
the brain and spinal cord and has cells that look
• Benign and slow-growing tumor that can affect
very different from normal cells. Glioblastoma
parts of your or your child’s endocrine system.
multiforme usually occurs in adults and affects the
Tumor symptoms can take years to surface, but
brain more often than the spinal cord. Also called
most tumors are found in children ages 5 to 14.
GBM, glioblastoma, and grade IV astrocytoma.
Healthcare providers treat these tumors with
COMMON TYPES INCLUDE surgery and radiation therapy.
• Glioblastoma Multiforme CHORDOMA
• Astrocytoma
• Chordomas are tumors that can occur anywhere
• Oligodendroglioma
within the spine or the base of the skull. The two
• Ependymoma
most common locations for chordomas are the
MENINGIOMA lower back (sacral area — approximately one-
third to one-half of chordomas) and the base of
• A type of slow-growing tumor that forms in the
the skull (approximately one-third of chordomas).
meninges (thin layers of tissue that cover and
protect the brain and spinal cord). Meningiomas METASTATIC BRAIN TUMOR
usually occur in adults.
• Happens when cancer in one part of your body
MEDULLOBLASTOMA spreads to your brain. Healthcare providers treat
brain metastases with surgery and radiation
• The most common type of cancerous brain
therapy. They may combine surgery with other
tumor in children. a cancerous brain tumor that
treatments to minimize the brain tumor's impact
starts in the lower back part of the brain. This part
and help you maintain your quality of life.
of the brain is called the cerebellum. It is involved
in muscle coordination, balance and movement. PRIMARY CENTRAL NERVOUS SYSTEM
LYMPHOMA (PCNSL)
SCHWANNOMA (Vestibular Schwannoma)
• Primary central nervous system (CNS)
• Usually a slow-growing tumor that develops
lymphoma is a disease in which malignant
from the balance and hearing nerves supplying
(cancer) cells form in the lymph tissue of the brain
the inner ear.
and/or spinal cord. Having a weakened immune

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CELLULAR ABERRATIONS NCM 113

SULTAN KUDARAT STATE UNIVERSITY | COLLEGE OF HEALTH AND SCIENCES

system may increase the risk of developing • If the tumor has spread to other parts of
primary CNS lymphoma. the central nervous system (CNS) or body
• Possible side effects
• The patient’s preferences and overall
DETECTING AND EVALUATION TEST health

• Medical History and Physical Examination

• Neurological Examination
CORTICOSTEROIDS.
• Imaging Studies
These drugs are used to lower swelling in the
• Biopsy
brain, which can lessen headache pain from the
• Cerebrospinal Fluid Examination
swelling without the need for prescription pain
• Angiography
medications. These drugs may also help improve
• Electroencephalogram (EEG)
neurological symptoms by decreasing the
• Neuropsychological Testing
pressure from the tumor and swelling in the
• Genetic Testing
healthy brain tissue.
MANAGEMENT AND TREATMENT
ANTI-SEIZURE MEDICINES.
Brain and nervous system cancer care often These help control seizures, and there are
include a mix of treatment approaches: several types of drugs available. These
medications are prescribed by your neurologist.
• SURGERY — the main treatment for most
Some drugs are better at going through the
tumors of the brain, spinal cord, and nervous
blood-brain barrier. These are the drugs often
system.
used for a brain tumor, such as temozolomide
• RADIOSURGERY — the treatment of brain (Temodar), lomustine (CCNU), or others.
cancer with precisely directed radiation beams.
• For people with glioblastoma and high-grade
It's painless and doesn't require an incision.
glioma, the latest standard of care is radiation
• RADIATION THERAPY — varies depending on therapy with daily low-dose temozolomide. This is
the type and stage of brain or nervous system followed by monthly doses of temozolomide after
cancer. It mostly uses high-energy x-rays or radiation therapy for 6 months to 1 year.
concentrated radioactive materials to kill cancer
• For people with anaplastic astrocytoma that is
cells safely. Your care team will often pair
newly diagnosed or has not responded to
radiation with medical treatment.
treatment, temozolomide may be part of the
• MEDICAL ONCOLOGY - involves the use of recommended treatment plan.
anti-cancer drugs, gene therapy, biologic therapy,
PREVENTION
or regional perfusion to treat cancer. Side effects
vary with the type of treatment. Unfortunately, you can’t prevent a brain tumor.
You can reduce your risk of developing a brain
You may also have the chance to take part in
tumor by avoiding environmental hazards such as
clinical trials of the latest brain and nervous
smoking and excessive radiation exposure.
system cancer treatments.
• If you have a first-degree biological relative
TREATMENT OPTIONS AND
(sibling or parent) who has been diagnosed with a
RECOMMENDATIONS DEPEND ON SEVERAL
brain tumor, it’s important to tell your healthcare
FACTORS:
provider. They may recommend genetic
• The size, type, and grade of the tumor counseling to see if you have an inherited genetic
• Whether the tumor is putting pressure on syndrome that’s associated with brain tumors.
vital parts of the brain PROGNOSIS

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REPUBLIC OF THE PHILIPPINES

CELLULAR ABERRATIONS NCM 113

SULTAN KUDARAT STATE UNIVERSITY | COLLEGE OF HEALTH AND SCIENCES

The 5-year relative survival rate for a cancerous
brain or CNS tumor is almost 36%. The 10-year
survival rate is over 30%. The survival rates for a
brain tumor vary based on several factors.
population. Europe (52 993 cases) accounted for
8.8%, followed by Africa (27 546 cases) at 4.6%,
Northern America (20 806 cases) at 3.4%, Latin
America and the Caribbean (19 011 cases) at
3.1%, and Oceania (2192 cases) at 0.4%

NATIONAL:
NURSING CONSIDERATIONS Esophageal cancer ranked 21 as the most
diagnosed cancer in the Philippines in new cases
The following are the nursing priorities for
of cancer according to statistics made by the
patients with brain tumors:
WHO in the year 2020. It also ranked 23 as the
• Assess neurological status most common cause of deaths by cancer as
• Manage symptoms and provide comfort stated by the World Health Organization. The
• Monitor for complications and changes in number of deaths caused by cancer of the
condition esophagus as of the year 2020 was 1122 and the
• Provide education and support to patients number of new cases was 1144.
and their families. PATHOPHYSIOLOGY
• Promote self-care and independence
• Provide palliative care, if needed.
GASTROINTESTINAL, ESOPHAGEAL,
STOMACH CANCER
ESOPHAGEAL CANCER OVERVIEW
The tenth most prevalent cancer in the world is
esophageal cancer. It begins in the esophagus, a
long muscular tube that transports food from your
throat to your stomach. Esophageal cancer
tumors sometimes don't show symptoms until
their cancer has advanced. Esophageal cancer
develops when malignant cells in the tissue of the
esophagus start to grow and ultimately form a
tumor. Though
esophageal cancer is aggressive, many sufferers
don't exhibit any signs until the cancer has
spread. That's because the esophagus expands
to accommodate huge objects, including
enormous food bites. The esophagus' entrance Adenocarcinoma and squamous cell carcinoma are the
begins to become blocked as the tumor enlarges. two cell types that can cause esophageal cancer.
Then, the person who has the cancer can GERD and esophageal cancer seem to be related in
some way. Esophageal cancer is more common in
experience swallowing issues or swallowing pain.
people with Barrett's esophagus or BE. Squamous
EPIDEMIOLOGY dysplasia is the precursor lesion for squamous cell
carcinoma, which is associated with smoking and
International: Esophageal cancer is the 10th most tobacco use and more frequently affects the middle
common cancer in the world. For both sexes esophagus. Adenocarcinoma is linked to
combined, in 2020, nearly 79.7% of new cases of gastroesophageal reflux disease (GERD), most
esophageal cancer were detected in Asia (481 frequently affects the distal esophagus, and Barrett's
552 cases), which represents 59.5% of the global esophagus is the precursor lesion. In the context of
gastro-esophageal reflux, Barrett's esophagus is the
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SULTAN KUDARAT STATE UNIVERSITY | COLLEGE OF HEALTH AND SCIENCES
most significant etiological cause for EAC. Then,
cancerous cells form on the esophageal surface,
creating irritation or a tumor that can cause dysphagia,
a feeling of a mass in the throat, painful swallowing,
substernal pain or fullness, and regurgitation of
partially digested food. In later stages, tumor cells of
adenocarcinoma and of squamous cell carcinoma may
spread below the esophageal mucosa or directly into,
through and beyond the muscle layers into the
lymphatics. Obstruction of the esophagus is noted,
with possible perforation into the mediastinum and
erosion into the great vessels.
RISK FACTORS
Having gastroesophageal reflux disease (GERD) -
The cells that make up the lining start to alter when the
esophagus is constantly coated in acid because it
seeks to defend itself. Cancer may develop from these
alterations in the future.
Smoking - Any consumption of tobacco's chemicals
damages the DNA of the cells that line the esophagus
and hinders the repair of already damaged DNA.
Furthermore, smoking impairs theesophageal
sphincters, the muscular valves that keep liquids in the
stomach and protect the esophagus. Smoking-related
damage allows stomach acid to flow back into the
esophagus, increasing the risk of heartburn or
gastroesophageal reflux disease (GERD), which is
another condition that can cause esophageal cancer.
Having precancerous changes in the cells of the
esophagus (Barrett's esophagus) - When you have
Barrett's esophagus, the tissue lining your esophagus
is replaced with tissue that resembles the lining of your
intestine. Esophageal adenocarcinoma is an
uncommon kind of cancer that can occur in people with
Barrett's esophagus.
Being obese - The risk of developing esophageal
adenocarcinoma is increased in those who are obese
or extremely overweight. This is explained in part by
the fact that people who are obese are more likely to
have gastroesophageal reflux.
Drinking alcohol - Alcohol converts to acetaldehyde in
your body, a compound that harms DNA. Additionally, it
reduces your capacity for absorbing important vitamins
and nutrients, has the potential to change hormone
levels, and may irritate the lining of your esophagus.
Having bile reflux - Gastric acid (stomach acid) that
refluxes into your esophagus may be accompanied by
bile reflux. Gastroesophageal reflux disease (GERD)
may develop as a result of gastric reflux. That may
ultimately cause esophageal cancer.
Having difficulty swallowing because of an
esophageal sphincter that won't relax (achalasia) -
The lower esophageal sphincter, a muscle near the
end of the esophagus, does not fully relax in this
condition. Food and fluids ingested have a hard time
getting into the stomach and often end up
accumulating in the lower esophagus, which over time
stretches out (dilates). When meals are exposed for
longer than usual periods of time, the cells lining the
esophagus in that location might get inflamed.
Having a steady habit of drinking very hot liquids -
Hot beverages can cause esophageal cancer by
causing thermal injury to the mucosa of the
esophagus.
SIGNS AND SYMPTOMS
• Difficulty and pain with swallowing
• Pressure or burning in the chest
• Indigestion or heartburn
• Vomiting
• Frequent choking on food
• Unexplained weight loss
• Coughing or hoarseness
• Pain behind the breastbone or in the throat
TYPES
ADENOCARCINOMA - The cells of the mucus-
secreting glands in the esophagus are where
adenocarcinoma develops. The lower part of the
esophagus is where adenocarcinoma most frequently
develops.
SQUAMOUS CELL CARCINOMA - The lining of the
esophagus is covered in flat, thin cells called
squamous cells. Most frequently, squamous cell
carcinoma develops in the upper and middle
esophagus. Globally, squamous cell carcinoma is the
most common esophageal cancer.
DETECTING AND EVALUATION TEST
The following tests and techniques are used to identify
esophageal cancer:
BARIUM SWALLOW STUDY - A person consumes a
barium-containing liquid during this investigation,
and then they are subjected to X-rays. The esophagus'
inside is coated with barium, which causes any
alterations to the tissue to be visible on the X-ray.
USING A SCOPE TO EXAMINE YOUR ESOPHAGUS
(ENDOSCOPY) - A flexible tube with a video lens is
passed down your neck and into your esophagus by
your doctor during endoscopy. Your doctor checks your
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SULTAN KUDARAT STATE UNIVERSITY | COLLEGE OF HEALTH AND SCIENCES
esophagus using an endoscope to check
inflammation or cancer.
COLLECTING A SAMPLE OF TISSUE FOR
TESTING (BIOPSY). - A biopsy may be performed by
your doctor using an endoscope, a special scope that
is passed down your mouth and into your esophagus.
A laboratory examines the tissue sample to check for
cancer cells. Several imaging techniques may
provide useful diagnostic information
CT SCAN - A CT scan of the chest and abdomen is
useful for detecting anatomic signs of metastatic
illness, particularly in the lungs, liver, and kidney.
POSITRON EMISSION TOMOGRAPHY (PET) SCAN
- A PET scan may also aid in the detection of
metastases.
ENDOSCOPIC ULTRASOUND - is used to evaluate if
cancer has spread to the lymph nodes and other
mediastinal tissues, as well as the tumor's size and
invasiveness.
EXPLORATORY LAPAROSCOPY - In individuals with
distant lesions, exploratory laparoscopy is the most
effective approach for locating positive lymph nodes.
MANAGEMENT AND TREATMENT
Esophageal cancer treatment depends on the cancer
stage and grade. Treatment options include:
SURGERY - The most frequent therapy for early-stage
esophageal cancer is an esophagectomy. It entails the
removal of some or all of your esophagus and
surrounding tissue. Surgeons build a new esophagus
by lifting up a portion of your stomach and inserting it
into your chest and neck.
RADIATION THERAPY - By directing a radiation beam
towards the tumor, radiation kills or destroys
cancer cells. Before or after surgery, healthcare
practitioners may utilize radiation as supplemental
therapy.
CHEMOTHERAPY. - Chemotherapy either kills or
stops cancer cells from growing.
ESD OR ENDOSCOPIC SUBMUCOSAL
DISSECTION. - ESD may be used by surgeons to
treat very earlystage esophageal cancer.
ENDOSCOPIC MUCOSAL RESECTION (EMR) - This
treatment is used by surgeons to remove tumors from
the mucous lining of your esophagus.
NCM 113
for ENDOSCOPIC LASER THERAPY - This treatment
relieves symptoms when tumors obstruct your
esophagus, making swallowing difficult.
PHOTODYNAMIC THERAPY (PDT) - Photodynamic
therapy uses medications called photosensitizers to
eliminate tumors. These drugs are activated by light,
causing a chemical reaction that kills cancer.
TARGETED THERAPY - Certain esophageal cancer
cells have an abnormally high level of the HER2
protein. This protein promotes the growth of cancer
cells. Drugs targeting HER2 proteins are used to treat
esophageal cancer in targeted therapy.
IMMUNOTHERAPY - immune checkpoint inhibitors
are used in this treatment. These medications aid in
the restoration of your immune system's reaction
against esophageal cancer cells.
PREVENTION
STOP SMOKING - Smoking raises the risk of
esophageal cancer, particularly squamous cell
carcinoma.
DRINK IN MODERATION - Alcohol is a known human
carcinogen and can cause esophageal lining damage
over time.
MANAGE GASTROESOPHAGEAL REFLUX
DISEASE - You have a slightly elevated risk of
esophageal adenocarcinoma if you have
gastroesophageal reflux disease, or GERD, in which
acidic stomach contents ascend into the esophagus
two or more times each week.
MAINTAIN A HEALTHY WEIGHT - Obesity can
contribute to GERD because it may push acid into the
esophagus, increasing your chance of getting
esophageal cancer.
MANAGE ACHALASIA - Food can become lodged in
the lower esophagus and produce reflux or vomiting in
patients with achalasia. Food remaining in the
esophagus for longer than necessary may also irritate
it.
PROGNOSIS
It is essential to consult with your doctor if you wish to
know your prognosis. Doctors estimate esophageal
cancer survival rates by how groups of people with
esophageal cancer have done in the past. The overall
five-year survival rate for esophageal cancer is about
20%, but survival rates can range from 5% to 47%.
The five-year survival rate is greater when esophageal
cancer is detected early and small. When it has grown
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SULTAN KUDARAT STATE UNIVERSITY | COLLEGE OF HEALTH AND SCIENCES
to a considerable size or spread to other regions of the
body, therapy becomes more complicated, and the
five-year survival rate drops.
NURSING CONSIDERATIONS
• Providing Emotional Support and Assisting in
Grieving
• Managing Acute Pain
• Improving Nutritional and Fluid Volume Status
• Minimizing Infection Risk
• Reducing Fear and Anxiety and Providing
Emotional Support
• Administer Medications and Provide
Pharmacologic Support
MULTIPLE MYELOMA
OVERVIEW
Multiple myeloma is a cancer that forms in a type of
white blood cell called a plasma cell. Healthy plasma
cells help fight infections by making proteins called
antibodies. Antibodies find and attack germs. In
multiple myeloma, cancerous plasma cells build up in
bone marrow. The bone marrow is the soft matter
inside bones where blood cells are made. In the bone
marrow, the cancer cells crowd out healthy blood cells.
Rather than make helpful antibodies, the cancer cells
make proteins that don't work right. This leads to
complications of multiple myeloma.
EPIDEMIOLOGY
NATIONAL:
Multiple myeloma remains to be an incurable
hematologic entity, but with the advent of novel agents
more patients experience significantly longer survival.
In a third world country like the Philippines, autologous
bone marrow transplant after chemotherapy for newly
diagnosed cases which is the standard of care is
difficult to comply. The management paradigm for
myeloma has shifted over the years, hence this study.
Data for six years were retrospectively collected from a
single tertiary institution.
• The clinical characteristics at diagnosis, treatment
and survival rates of 109 active myeloma patients were
described.
• The median age was 61 years (range, 28–83), with
51.4% being female. Median overall survival was 49.5
months (95% CI 42.7–56.2).
• The frontline treatments of patients were also
analyzed. The combined deep response (complete and
very good partial) of our patients at 31.7% was higher
than that of Asian Myeloma Network Study at 30.9%.
None of them have yet undergone autologous bone
marrow transplantation as of date. Novel agents,
especially bortezomib, were used in 35.7% and
significantly affected overall and progression-free
survivals when used as a first line treatment.
INTERNATIONAL:
• The age-standardized rate (ASR) of multiple
myeloma incidence was 1·78 (95% UI 1·69–1·87) per
100 000 people globally and mortality was 1·14 (95%
UI 1·07–1·21) per 100 000 people globally in 2020.
Increased incidence and mortality were associated
with higher human development index, gross domestic
product, prevalence of physical inactivity, overweight,
obesity, and diabetes.
PATHOPHYSIOLOGY
The pathophysiologic basis for the clinical sequelae of
MM involves the skeletal, hematologic, renal, and
nervous systems, as well as general processes (see
below).
Multiple myeloma begins with one plasma cell in the
bone marrow. Something happens that turns the
plasma cell into a cancerous myeloma cell. The
myeloma cell begins making a lot more myeloma cells
quickly.
The myeloma cells continue trying to make antibodies,
as healthy plasma cells do. But the body can't use
these antibodies, called monoclonal proteins or M
proteins. Instead, the M proteins build up in the body
and cause problems, such as damage to the kidneys.
Myeloma cells can damage bones and increase the
risk of broken bones.
A CONNECTION WITH MGUS
Multiple myeloma starts as a condition called
monoclonal gammopathy of undetermined
significance, also called MGUS. In MGUS, the level of
M proteins in the blood is low. The M proteins don't
cause damage in the body.
RISK FACTORS
Things you should know about risk factors for cancer:
• Risk factors can increase a person's risk, but
they don't always cause the disease.
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SULTAN KUDARAT STATE UNIVERSITY | COLLEGE OF HEALTH AND SCIENCES
• Some people with risk factors never develop
cancer. Other people with cancer have no
known risk factors.
• Some risk factors are very well known. But
there's ongoing research about risk factors for
many types of cancer.
WHO IS AT RISK FOR MULTIPLE MYELOMA?
Anyone can get multiple myeloma. But there are some
factors that can increase your risk, such as:
• OLDER AGE. Most people who have this cancer are
over age 65. It’s very rare before age 40.
• RACE AND ETHNICITY. African Americans have
more than twice the risk as white Americans. The
reason is unknown. Multiple myeloma is more common
in the Middle East, North Africa, and the
Mediterranean.
• GENDER. Men have a slightly higher risk than
women.
• FAMILY HISTORY. People with a family history of
multiple myeloma have an increased risk. Still, most
people who get it don't have a family history of the
disease.
• HAVING A SOLITARY PLASMACYTOMA. People
who have had a single plasma cell tumor are more
likely to get multiple myeloma at some point.
• HAVING MONOCLONAL GAMMOPATHY OF
UNDETERMINED SIGNIFICANCE (MGUS). In this
condition, abnormal plasma cells make too much of a
specific antibody (M protein). This can be found in your
blood. It doesn't cause symptoms like it does in
myeloma. Still, people with MGUS are more likely to go
on to get multiple myeloma.
• EXPOSURE TO RADIATION OR TO CERTAIN
CHEMICALS. People exposed to high levels of
radiation seem to have a higher risk. Being exposed to
certain chemicals, such as benzene and some
pesticides and herbicides, can also raise your risk.
Carpenters, furniture makers, and paper makers may
be at higher risk.
• OBESITY OR OVERWEIGHT. People who are obese
or overweight have a higher risk of developing multiple
myeloma.
SIGN AND SYMPTOMS
Early in multiple myeloma, there might be no
symptoms. When signs and symptoms happen, they
can include:
NCM 113
• Bone pain, especially in the spine, chest or
hips - the most common symptom
• Nausea - early signs
• Constipation
• Loss of appetite
• Mental fogginess or confusion
• Tiredness
• Infections
• Weight loss
• Weakness
• Thirst
• Needing to urinate often.
NOTE: Sometimes, people with multiple myeloma do
not have any of the symptoms and signs described
below. For people with myeloma who have no
symptoms, their cancer may be discovered by a blood
or urine test that is performed for a different reason,
such as for an annual physical exam. Or, the cause of
a symptom or sign may be a medical condition that is
not cancer.
• Anemia
• Fatigue
• Bone pain
• Pain, numbness, and weakness
• Too much M protein — may lead to kidney
damage or failure (symptoms include itching,
weakness, fatigue, shortness of breath,
muscle cramps, nausea, appetite loss, trouble
sleeping, urination changes, anemia, and
swelling of the legs, feet, or ankles.)
• Hypercalcemia (It can cause drowsiness,
constipation, and kidney damage.)
• Fever and infections — especially of the
upper respiratory tract and lungs.
• Blood clots, nosebleeds, bleeding gums,
bruising, cloudy vision caused by
hyperviscosity, which is thickened blood, and
low platelets are other symptoms of multiple
myeloma
DETECTING AND EVALUATION TEST
Sometimes a health care professional finds multiple
myeloma during a blood test for another condition.
Other times your symptoms may lead your health care
professional to test for multiple myeloma.
Tests and procedures to diagnose multiple
myeloma include:
BLOOD TESTS . The M proteins made by myeloma
cells can show up in a sample of blood. Blood tests
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SULTAN KUDARAT STATE UNIVERSITY | COLLEGE OF HEALTH AND SCIENCES
also might find another protein myeloma cells make,
called beta-2-microglobulin.
Other blood tests give your health care team clues
about your diagnosis. These tests might include tests
that look at kidney function, blood cell counts, calcium
levels and uric acid levels.
URINE TESTS . M proteins can show up in urine
samples. In urine, the proteins are called Bence Jones
proteins.
BONE MARROW TEST. . Bone marrow biopsy and
bone marrow aspiration are used to collect bone
marrow samples for testing. Bone marrow has a solid
and a liquid part. In a bone marrow biopsy, a needle is
used to collect a small amount of the solid tissue. In a
bone marrow aspiration, a needle is used to draw a
sample of the fluid. The samples are typically taken
from the hip bone.
The samples go to a lab for testing. In the lab, tests
look for myeloma cells. Other special tests give your
health care team more information about your
myeloma cells. For example, the fluorescence in situ
hybridization test looks for changes in the cells' genetic
material, called DNA.
IMAGING TESTS . Imaging tests can show bone
problems linked with multiple myeloma. Tests may
include an X-ray, MRI scan, CT scan, or positron
emission tomography scan, also called PET scan.
MANAGEMENT AND TREATMENT
Treating symptoms and complications of myeloma. As
well as the main treatments for multiple myeloma, you
may also need treatment to help relieve some of the
problems caused by the condition.
For example:
• PAINKILLERS – to reduce pain
• RADIOTHERAPY – to relieve bone pain or help
healing after a bone is surgically repaired
• BISPHOSPHONATE MEDICINE GIVEN AS
TABLETS OR BY INJECTION – to help prevent bone
damage and reduce the levels of calcium in your blood
• BLOOD TRANSFUSIONS OR ERYTHROPOIETIN
MEDICINE – to increase your red blood cell count and
treat anaemia
• SURGERY – to repair or strengthen damaged bones,
or treat compression of the spinal cord (the main
column of nerves running down the back)
NCM 113
• DIALYSIS – may be required if you develop kidney
failure
• PLASMA EXCHANGE – treatment to remove and
replace the liquid that makes up blood (plasma) if you
have unusually thick blood
These treatments can each cause side effects and
complications. Make sure you discuss the potential
risks and benefits with your treatment team.
PHARMACOLOGIC TREATMENT
Chemotherapy (chemo) is the use of certain kinds of
drugs that destroy or control the growth of cancer cells.
These drugs can be taken by mouth or given in a vein
or a muscle. They enter the bloodstream and reach
almost all areas of the body.
At one time, chemo was often part of the main
treatment for multiple myeloma. As newer types of
drugs have become available in recent years, chemo
has become less important in treating myeloma,
although it is still used in some situations.
Chemo drugs that can be used to treat multiple
myeloma include:
• Cyclophosphamide (Cytoxan)
• Etoposide (VP-16)
• Doxorubicin (Adriamycin)
• Liposomal doxorubicin (Doxil)
• Melphalan
• Bendamustine (Treanda)
PREVENTION
With multiple myeloma, there are no risk factors you
can avoid to prevent the disease. There is no known
way to prevent the disease in those who have other
plasma cell diseases.
PROGNOSIS
WHAT IS THE LIFE EXPECTANCY OF MULTIPLE
MYELOMA?
• Some people live 10 years or more with multiple
myeloma. As with most types of cancer, early
diagnosis and treatment help people live longer. In this
case, 78% of people who have single plasmacytoma
are alive five years after diagnosis. The overall five-
year survival rate for people with multiple myeloma
ranges from 40% to 82%. These numbers are based
on the Revised Multiple Myeloma International Staging
System (R-ISS).
• It’s important to remember that statistics like these
are averages that don’t take factors like age or overall
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CELLULAR ABERRATIONS NCM 113

SULTAN KUDARAT STATE UNIVERSITY | COLLEGE OF HEALTH AND SCIENCES

health into consideration. If you have multiple

myeloma, your healthcare provider is your best
resource for information about your specific situation.

NURSING CONSIDERATION

Myeloma treatment includes: multi-drug chemotherapy

regimens, which work synergistically; supportive
treatments, such as bisphosphonates to protect
against bone damage; and prevention and
management of infection.

Therefore, treatment plans are complex and present

challenges to nurses and other health professionals
caring for patients with myeloma. Treatment may result
in an accumulation of toxicities, which themselves
need to be monitored and managed.

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