Multiple myeloma is a blood cancer that begins in your plasma cells. These cancerous cells can build up in your bone marrow and then cause bone damage. Myeloma can also lead to dangerous complications involving some vital organs like your kidneys.

There are several myeloma symptoms, including those that appear early, like bone pain, and others caused by treatments. But not everyone with myeloma will have every possible symptom. Your symptoms may depend on what type of myeloma you have.

Myeloma symptoms can usually be managed with a variety of effective treatment options. That said, distinguishing between symptoms of myeloma and treatment side effects can be hard. Here’s what you need to know about myeloma symptoms.

Skin Changes Linked With Myeloma

Myeloma treatments can cause skin problems. This includes rashes, itching, blisters, and changes in skin color or texture. Some chemotherapy drugs can damage the skin at the site where they’re injected.

In rare cases, myeloma can spread to your skin. When this happens, skin problems may include:

• Bruising
• Rashes
• Deposits of a protein called amyloid
• Skin lesions mimicking squamous cell skin cancer

If you notice bruising around the eyes (called periorbital purpura), it may be linked to amyloid light-chain (AL) amyloidosis. This is a rare disorder that can occur when your plasma cells turn into odd-shaped clumps.

Experts are unsure how this bruising, sometimes called racoon eyes, is related to myeloma. If you have this symptom, let your care team know as soon as possible.

Other Potential Myeloma Symptoms

There are several ways that myeloma can affect your body. And while you may not have every symptom, it’s important to be aware of what could occur. Here are some other symptoms of multiple myeloma.

Posture Changes and Loss of Mobility

Fractures in the vertebrae can cause the spine to collapse, causing posture changes. Advanced myeloma can cause a pronounced stoop and a loss of height. People with bone lesions may lose mobility and may find it painful to walk.

Kidney Damage

Normal plasma cells secrete antibodies — proteins that protect against infection. Myeloma cells make antibodies that are abnormal and ineffective, called M protein. In myeloma, kidney damage is possible.

More than half of people with myeloma have problems with kidney function. And about 2 percent to 4 percent of people with myeloma require dialysis.

If you develop kidney disease, you may have increased protein (or creatinine) in your urine. You may also have nausea, itching, confusion, and fatigue. If your kidneys are affected by high calcium levels, or hypercalcemia, you may be thirsty, urinate a lot, and become dehydrated.

Frequent Infections

People with myeloma are vulnerable to infections. This can be due to bacteria, viruses, and fungi that would be easily fended off by those with healthy immune systems. Common colds, the flu, and even pneumonia can be more severe in those with myeloma.

Myeloma compromises the immune system by reducing the number of healthy white blood cells that fight infection. This suppressed antibody production is called immunoparesis. It can make the immune system less efficient when fighting bacteria and viruses.

Myeloma treatments can further reduce levels of effective white blood cells. They can also suppress the immune system in other ways. For example, chemotherapy can lower white blood cell counts and increase infection risk.

Blood Clots and Abnormal Bleeding

Platelets are fragments of blood cells that play a major role in forming blood clots. In some people with myeloma, damage to bone marrow lowers the number of platelets. When this happens, it’s called thrombocytopenia.

Myeloma can increase the risk of venous blood clots, and some treatments can raise that risk further. Though rare, it’s also possible to experience abnormal bleeding. For instance, you may have nosebleeds, bleeding from the gums, or easy bruising.

Fatigue and Weakness

Nearly 3 out of 4 people with myeloma develop anemia (low red blood cell count). Anemia occurs because cancer cells crowd the bone marrow where red blood cells are produced. It can also be triggered by treatments.

Red blood cells carry oxygen, which your body needs to produce energy. In people with anemia, fatigue can be severe. Anemia may also lead to dizziness, pale skin, and shortness of breath.

Hypercalcemia is higher-than-normal levels of calcium in the blood. It’s another potential cause of muscle weakness and drowsiness in people with myeloma. It occurs when multiple myeloma destroys bone and large amounts of calcium are released into the bloodstream.

Neuropathy

Myeloma treatments can damage nerves, leading to neuropathy — pain, tingling, burning, or numbness, often in the extremities. Neuropathy caused by chemotherapy or other myeloma treatments may also persist for months after treatment ends. In some people, it’s permanent.

Neuropathy may also be a symptom of AL amyloidosis, which can occur with myeloma. For some people, nerve-related symptoms are the biggest complaint.

Gastrointestinal Issues

People with myeloma may have gastrointestinal (GI) issues. For instance, you may have nausea, vomiting, diarrhea, constipation, excessive thirst, and abdominal pain. Plus, around 1 out of 4 people with myeloma experience weight loss.

Some of these GI issues are linked to the condition itself, and some are side effects of treatment. For instance, some treatments can also cause sores in the mouth. Other medications, such as corticosteroids, may cause weight gain.

In addition, hypercalcemia can lead to nausea, vomiting, and constipation.

Hyperviscosity Syndrome

Very rarely, myeloma can cause hyperviscosity syndrome. This causes the blood to be too thick. This complication sometimes occurs in people recently diagnosed and may be related to a high number of tumors.

Hyperviscosity syndrome may lead to the following symptoms:

• Vision changes
• Nose or gum bleeding
• Dizziness
• Confusion
• Seizures

Swelling

You may also notice edema (swelling) in your face, ankles, legs, and abdomen. One cause is related to abnormal proteins, which can cause fluid to build up.

Another potential cause is abnormal free light chains. This refers to abnormal proteins in your body, which occurs sometimes in myeloma.

Managing edema may involve addressing underlying kidney issues. You may also need medications to address fluid retention. Keep in mind that changes in fluid intake are highly individualized since adequate hydration is important for kidney health.

How Multiple Myeloma Can Affect Your Cognition and Mood

The effects of multiple myeloma aren’t limited to your bones, skin, and kidneys. This blood cancer can impact you neurologically as well. And you may even notice changes in your mood.

Here are some cognitive symptoms you may experience.

Cognitive and Neurological Issues

Cognitive changes like memory issues, trouble focusing, or confusion can stem from “chemo brain.” This is a side effect of certain treatments or can be caused by the disease itself, especially if calcium levels in the blood are high or abnormal proteins disrupt blood flow in the brain.

In rare cases, myeloma can lead to more serious neurological problems. This may include seizures or weakness on one side of the body.

These may be signs of complications like spinal cord compression or hyperviscosity syndrome. You should report them to a doctor right away.

Mood and Mental Health Changes

Living with multiple myeloma can be emotionally challenging. It can lead to anxiety and depression, which are common among people with chronic illnesses. The stress of managing a serious health condition and the impact of symptoms like pain and fatigue can affect your mental health.

Even the side effects of treatment can contribute to mental health challenges. Seek support for your mental well-being if you’re feeling burdened by your condition or you’ve noticed changes in your mood or well-being. Your oncologist can refer you to providers who can help you manage mental health challenges.