MGUS & Multiple Myeloma

Each year many die of multiple myeloma. It is a cancer principally affecting bone but capable of metastasizing to the lung and soft tissue. A man or woman in their 40’s or 50’s suddenly suffering a fracture of some spinal element without any precedent trauma that they can recall is certainly a possible victim of this disease. Other primary bone cancers and infection are also possibilities.

In such a setting, physicians often will perform a test called Protein Urine Electrophoresis. This test is calculated to determine the presence in the urine of light chain protein. It is not very important that one understand what a light chain protein is.   It is important to understand that kidneys are not supposed to leak proteins and if they do leak proteins, it is a distinct possibility that a light chain protein is involved (also sometimes referred to as M proteins).

MGUS is not multiple myeloma. There are distinguished physicians who write ably and in detail about the differences. It is however also the case that if a person has evidence of MGUS and they live long enough, they suffer a one in four chances of dying of multiple myeloma, a terrible illness.

It is for this reason that it is worthwhile to be screened by urine electrophoresis testing any time there is an unexplained fracture.

There are some who follow MGUS simply by doing regular screening to determine whether the concentration of protein increases or not. These physicians will argue that there is no reliable evidence that treating multiple myeloma prior to its full-blown appearance does no good. On the other hand, if one doesn’t carefully monitor for this cancer by the time a diagnosis is made it is entirely possible that one will be suffering several crushed vertebrae with metastasis and other dreadful consequences. A delay in diagnosis worsens the outcome.

A client of ours once suffered a fracture while playing golf.  He did not fall or strike himself.  The fracture was of  a neck bone (cervical vertebra).  An intern appropriately considered the possibility that this unusual fracture without trauma might be due to osteomyelitis or some form of cancer such as multiple myeloma. Among the tests that were ordered was the urine protein electrophoresis examination.   The test was positive but was reported to no one.

It is essential when you are in the hospital for a workup for any illness that you take active steps to learn whether all lab results and imaging results have in fact been directly communicated to persons with an interest in your health.   A mistake in communication can have disastrous consequences.