Myeloma

Japanese: 骨髄腫 - こつずいしゅ（英語表記）Myeloma
Myeloma

What kind of disease is it and what causes it?

The cells that make blood are found in the bone marrow. There are several types of cells, and among them, the cells that make antibodies that work when bacteria or other substances enter the body are plasma cells, and when these become cancerous, they become myeloma.

Because it is a tumor of blood cells, it occurs frequently in bones throughout the body, usually Multiple myeloma ( Healthy living things ) It is called myeloma. It occurs in people over 40 years old, and tends to be more common in men. Some doctors even suspect myeloma when they see lower back pain in middle-aged men. In rare cases, it can occur singly in one bone.

It tends to occur in bones that actively produce blood. spine ( Spinal cord ) , pelvic bones, rib ( Rock ) It is most commonly found in the sternum and breastbone, but can also occur in the bones of the hands and feet.

A distinctive feature of this tumor compared to other malignant tumors that occur in the bones, such as osteosarcoma and chondrosarcoma, is that the tumor cells have the property of producing antibodies, causing an abnormal increase in the level of an antibody called immunoglobulin in the blood. Sometimes the antibody level does not increase, and in such cases a tissue test is required for diagnosis.

Because the tumor cells originate from blood cells, radiation therapy is effective, and chemotherapy (anticancer drugs) is also being developed. Although it is a bone disease, it is considered a systemic disease, and the treatment policy is decided by the hematology department.

How symptoms manifest

The main symptom is pain that gradually gets worse, but the location may change. neck ( Keibu ) It may be difficult to distinguish this from pain. It is not uncommon for the spine to suffer from compression fractures (pathological fractures).

On the other hand, in some cases, abnormally high antibody levels are detected during a blood test at a health check, and the disease is only discovered after an X-ray examination.

Testing and diagnosis

X-ray examination mainly shows osteolytic changes in which bones dissolve, sometimes called punched-out lesions. This lesion may be seen singly or multiple times. If it has spread throughout the body, osteoporosis ( Tips and tricks ) and may be indistinguishable.

Blood tests show an increase in certain immunoglobulins in about half of the patients, and a protein called Bence Jones protein, which is specific to myeloma, is detected in urine tests. Bone scintigraphy is effective in detecting the spread of the disease throughout the body.

Treatment methods

Radiation therapy is effective for localized treatment. If it is a single tumor, surgical removal may be performed. Since it is classified as a systemic disease, chemotherapy with anticancer drugs is used.

Those with solitary tumors who have undergone adequate surgical resection can be expected to survive for a long time, whereas those with multiple tumors are known to have a poor prognosis, although they respond to radiation therapy and chemotherapy.

What to do if you notice an illness

Please immediately consult a doctor specializing in bone and soft tissue tumors or visit a specialized hospital with a hematology department.

Kyoji Okada

Source: Houken “Sixth Edition Family Medicine Encyclopedia” Information about the Sixth Edition Family Medicine Encyclopedia

Japanese:

どんな病気か・原因は何か

　血液を作る細胞は骨髄のなかにあります。いくつかの種類の細胞があり、そのうち細菌などが体内に入ってきた時にはたらく抗体を作る細胞が形質細胞で、これががん化したものが骨髄腫です。

　血液細胞の腫瘍なので、全身の骨に多発し、通常は多発性骨髄腫(たはつせいこつずいしゅ)と呼ばれます。40歳以降の年齢層に発生し、男性に多い傾向があります。中年以降の男性の腰痛ではまず骨髄腫を疑うこと、という医師もいるくらいです。まれにひとつの骨に単発に発生することもあります。

　血液を活発に作っている骨に発生しやすいので、脊椎(せきつい)、骨盤の骨、肋骨(ろっこつ)や胸骨によくみられますが、手足の骨にも起こります。

　骨肉腫や軟骨肉腫などの骨に発生する悪性腫瘍と比べて特徴的なことは、腫瘍細胞が抗体を作る性質をもっていることで、血液のなかに免疫グロブリンという抗体が異常に増えます。時々抗体の値が高くならないこともあり、そのような時の診断には組織検査が必要です。

　腫瘍細胞が血液細胞に由来するので、放射線療法がよく効き、また化学療法（抗がん薬）の開発も進んでいます。骨の病気ですが、全身の病気として位置づけられて、治療の方針は血液内科で決められています。

症状の現れ方

　主な症状は、徐々に強くなる痛みですが、場所が移動することがあります。加齢的変化による腰痛や頸部(けいぶ)痛などと区別のつかないことがあります。脊椎などは、圧迫骨折（病的骨折）を起こすこともまれではありません。

　一方、健診などの血液検査で抗体の異常高値を指摘され、X線検査をしてみて初めて発見されることもあります。

検査と診断

　X線検査では骨が溶ける溶骨性の変化が主体で、打ち抜き像と呼ばれることがあります。この像が単発、または多発してみられます。全身に広がっている場合には、骨粗鬆症(こつそしょうしょう)と区別のつかないことがあります。

　血液検査で約半数にある種の免疫グロブリンの上昇を認め、尿検査で骨髄腫に特異的なベンス・ジョーンズ蛋白と呼ばれる蛋白が検出されます。全身への広がりの検索には、骨シンチグラフィーが有効です。

治療の方法

　局所に対する治療は、放射線療法が有効です。単発であれば外科的切除を行うこともあります。全身疾患として位置づけられるので、抗がん薬による化学療法が行われています。

　単発性で十分な外科切除の行われたものは長期生存が期待できますが、多発性のものは放射線療法や化学療法に反応しますが、予後は悪いことが知られています。

病気に気づいたらどうする

　ただちに骨軟部腫瘍の専門の医師に相談するか、血液内科のある専門病院を受診してください。

岡田　恭司

出典　法研「六訂版 家庭医学大全科」六訂版 家庭医学大全科について　情報

<<:  Myelofibrosis (myelofibrosis)

>>:  Osteomyelitis (Suppurative osteomyelitis)

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