Bone marrow cancer: causes, symptoms, diagnosis, treatment

Oncological disease of myeloid (hematopoietic) tissue belongs to the category of hemoblastosis, and this is actually bone marrow cancer. It should be noted that cancer cells from the bone marrow are capable of affecting bone tissue, and then various forms of bone cancer develop. And they can cause oncological damage to the blood.

Speaking of bone marrow cancer, specialists are referring to cancer of the most important hematopoietic organ in humans, which is located in the spongy tissue of the bones (end sections of the long tubular bones and cavities of many spongy bones, including the bones of the pelvis, skull, sternum). It is the special cells of the myeloid tissue of the bone marrow - hematopoietic stem cells - that synthesize leukocytes, platelets, erythrocytes, as well as eosinophils, neutrophils, basophils and mononuclear phagocytes. Bone marrow does not synthesize lymphocytes, but instead contains B-lymphocytes, which recognize genetically foreign substances (antigens) in our bodies, begin to produce protective antibodies and “release” them into the blood, ensuring the functioning of the immune system.

[1], [2], [3]

Causes of bone marrow cancer

In the course of numerous studies of the causes of bone marrow cancer, it turned out that, apart from other organs, the bone marrow is affected quite rarely. A much more common situation is when the bone marrow becomes the target of metastasis. According to oncologists, cancer metastases in the bone marrow are most often observed in patients with malignant neoplasms of the lung, thyroid, mammary glands, prostate, as well as in neuroblastoma in children (cancer of the sympathetic nervous system). In the latter case, bone marrow metastases appear in more than 60% of patients. While cancer metastases in the bone marrow for malignant tumors of the colon occur only in 8% of cases. Dissemination (spreading) of cancer cells from the primary tumor site occurs in the blood and lymph, and thus the cancer cells multiply uncontrollably enter the bone marrow.

However, there is a primary bone marrow cancer, the true causes of which today are not known for certain. Factors such as infections, harmful chemicals or other adverse environmental effects may play a role in the development of bone marrow cancer, but there is no hard evidence. As there are no valid arguments that there is a hereditary factor.

Most researchers tend to see the causes of bone marrow cancer in the somatic mutation of plasma cells - the main cells that produce antibodies and are the final stage in the development of a B-lymphocyte. According to this version, bone marrow cancer — bone marrow sarcoma or myeloma disease — arises from the destruction of myeloid tissue, which occurs as a result of excessive plasma cell counts. Sometimes plasma cells can completely force out normal hematopoietic tissue from the bone marrow.

[4], [5], [6]

Symptoms of bone marrow cancer

Bone marrow cancer, as medical statistics show, affects mainly men after 50 years, but can also develop in younger people. The disease has two forms: with one focus (solitary) and multiple (diffuse).

Domestic and foreign oncologists point out the following main clinical symptoms of bone marrow cancer:

• anemia, in which a person quickly gets tired, complains of weakness and dizziness. Sometimes anemia is the first and foremost manifestation of the disease;
• persistent and aggravated pains in the bones (most often in the lower back, pelvis and ribs);
• bruises on the body and bleeding gums (blood clotting problems associated with low platelet count);
• compression of the spinal nerve endings, which is expressed in weakness of the leg muscles, numbness of certain parts of the body or legs, pain in the bladder or intestines and problems with their emptying;
• increased thirst, nausea, vomiting, constipation (indicate a high level of calcium in the blood - hypercalcemia);
• nosebleeds, blurred vision, headaches, drowsiness (associated with increased blood viscosity due to a very high level of anomalous protein of the immunoglobulin class - paraprotein);
• sites of bone marrow and bones (pelvis, ribs, sternum, skull, less often - long bones) in the form of holes of various sizes, but always round shape with clear boundaries;
• swelling over the tumor focus.

In a diffuse form of bone marrow cancer (myeloma), symptoms such as are observed:

• progressive anemia of the normochromic type, exhaustion, weight loss;
• bone pain;
• the dimensions of the single lesion nodes increase and merge, causing the bone tissue to thicken;
• systemic osteoporosis, that is, a decrease in bone density and strength (may be accompanied by pathological fractures);
• the lesion extends to the spine, causing its curvature (kyphoscoliosis of the thoracic region);
• susceptibility of patients with bacterial infections due to a significant decrease in immunity (due to hypogammaglobulinemia).

[7], [8], [9]

Stages of bone marrow cancer

At the first stage, and often at the second stage of bone marrow cancer, this disease is rarely diagnosed, as patients take the pains of radiculitis that torment them, and doctors take osteochondrosis, rheumatism, or primary radiculoneuritis. If patients go to a urologist about kidney problems, they immediately suspect urolithiasis or pyelonephritis. And only on ultrasound local pathological lesions of the bone tissue are detected.

The last stage of any cancer is the condition when the tumor metastases to the lymph nodes and other organs. Grade 4 bone marrow cancer is an extensive bone marrow sarcoma with metastases or a diffuse form of myeloma.

[10], [11], [12], [13]

Diagnosis of bone marrow cancer

It is clear that the symptoms of bone marrow cancer may not be the only basis for diagnosis. Moreover, the diagnosis should be differentiated. Laboratory blood tests (biochemical and determination of IgM antibodies in the blood), urine, feces, as well as histological examination of particles of affected tissues (biopsy) and biochemical analysis of myeloid tissue (bone marrow puncture) are necessary.

In the diagnosis of bone marrow cancer, radiographic methods, bone scintigraphy, computed tomography (CT), and magnetic resonance imaging (MRI) are required.

97% of patients with bone marrow cancer show abnormal blood and urine tests for protein.

A blood test for bone marrow cancer is very specific. Thus, the color indicator of blood (that is, the relative content of hemoglobin in one erythrocyte) is close to unity (at a rate of 0.85-1.05). Indicators of ESR increased. A characteristic of anemia is a change in the shape of erythrocytes (poikilocytosis), a significant difference in the size of erythrocytes in the same person (anisocytosis) with a large percentage of erythrocytes that are abnormally small in size (microcytosis).

At the same time, the number of nuclear forms of erythrocytes and erythroblasts (intermediate cells of the development of red blood cells) is increased in the blood of patients with bone marrow cancer. The number of reticulocytes (young red blood cells, which are formed in the bone marrow and circulate in the blood) is also above the norm. But the platelet count in the blood test for bone marrow cancer is significantly below the normative level.

To confirm the diagnosis, a histological analysis of the bone marrow is done - a biopsy (trepanobiopsy), and a myelogram based on its results allows an objective assessment of the state of the bone marrow cells.

[14], [15]

Bone marrow cancer treatment

Treatment for bone marrow cancer depends on the form of the disease. In the case of a solitary form of myeloma, the main treatment method is surgical, in which the lesion is removed.

Symptomatic treatment is also prescribed, which is aimed at relieving pain (taking painkillers); bone strengthening (bone protectors - bisphosphonates); increase in the content of erythrocytes in the blood (steroid hormonal agents).

To improve the composition of patients' blood and reduce the level of paraprotein in it, exchange transfusion or membrane plasma exchange can be used.

If the lesions are solitary, a course of radiation therapy is conducted. For diffuse myeloma, various chemotherapy regimens are used to stop their multiplication of cancer cells.

Stem cell transplantation can be one of the treatment options for bone marrow cancer. This treatment is not suitable for all cases, however, it gives a greater chance of complete remission. Stem cells are usually obtained from the blood of a patient with cancer before radiotherapy or chemotherapy.

The total duration of the treatment of bone marrow cancer before remission may be about a year. In many cases, when there is partial remission, at some point the disease returns (relapses). Over time, the treatment of relapses becomes more complicated and difficult.

[16], [17]

Prevention of bone marrow cancer

It should be noted that the decrease in immunity plays an important role in the development of bone marrow cancer. Therefore, to provide the body with substances that are useful for bone marrow, it is recommended to eat:

• fat-rich sea fish (as a source of essential fatty acids);
• chicken meat (proteins, selenium, vitamins of group B);
• walnuts (iron, cobalt, copper, iodine, zinc, manganese and polyunsaturated fatty acids);
• peanuts (arachidonic acid);
• chicken eggs (lutein);
• sea kale (iodine).

Adequate correction of hypercalcemia is very important, so people with a diagnosis of bone marrow cancer (myeloma) are usually advised to drink plenty of fluids - at least three liters per day. It helps to reduce high calcium levels.

[18], [19], [20], [21], [22], [23], [24]

Bone Marrow Cancer Prediction

The most common prognosis of bone marrow cancer is unfavorable. Although with primary solitary myeloma without metastases, patient survival is 75-80%. In most cases, osteogenic tumors lead to death, that is, when cancer cells from the bone marrow penetrated into the bones and caused bone cancer (osteogenic sarcoma, chondrosarcoma, chordoma, Ewing's sarcoma, etc.).

[25], [26], [27]

How many live in bone marrow cancer?

In general, with timely detection and treatment, about half of people live 3-4 years. In some cases, the disease responds very well to treatment, and survival is much higher. In particular, successful stem cell transplantation provides good chances for complete remission of bone marrow cancer.

[28], [29]