With all forms of cancer, staging systems are used. These stages tell physicians how far advanced the cancer is. Multiple myeloma is a unique type of cancer because it does not spread in the way other cancers do. This is why there are also only three stages. As with all cancers, the earlier it is caught, the better would be the prognosis. That said, the exact prognosis varies based on a range of factors other than the multiple myeloma stages as well. Staging is important not just for prognosis, but also to determine appropriate treatment. Two different types of staging systems are used in case of multiple myeloma.
1. The Durie-Salmon Staging System
Historically, the Durie-Salmon system was the only test that could determine multiple myeloma stages. This system was able to determine the clinical stage of the disease, which is stage I, II, or III. It specifically looks at four different measurements:
1. The M protein levels
2. The amount of lytic (tiny) bone lesions
3. The value of hemoglobin
4. The levels of serum calcium
STAGE I has hemoglobin levels of 10g/dL, a normal serum calcium value (12 mg/dL), scale 0 bone x-ray or a single plasmacytoma only, low production of M protein.
STAGE II does not meet the criteria of stage I, nor the criteria of stage II.
STAGE III has either a hemoglobin level of 12g/dL, scale 3 lytic bone lesions (advanced), and/or a high M protein production rate. At stage III, two multiple myeloma stages exist within it, which is A, whereby someone's serum creatinine value is below 2 mg/dL, which means the patient has reasonably normal renal function; or B, whereby the serum creatinine value is 2 mg/dL or above, which indicates abnormal renal function.
2. International Staging System (ISS)
The ISS is the newest staging system that is far more cost-effective and many say more accurate as well. To complete this system, two blood test results are gathered:
1. Levels of beta 2-microglobulin (B2-M)
2. Levels of albumin
It has been determined that the relationship between these two is the most accurate diagnostic tool for multiple myeloma. While new, it is far more sensitive than Durie-Salmon and therefore preferred. This is because the survival rates for each stage are very different, and having an accurate picture of which stage someone is in can lead to a much-improved prognosis because the right treatment is offered. Under this system:
STAGE I has B2-M levels below 3.5 mg/dL and albumin levels of 3.5 g/dL.
STAGE II meets neither the requirements of stage I, nor those of stage III.
STAGE III has B2-M levels above 5.5 mg/L
The prognosis with multiple myeloma differs depending on a range of factors. Prognostic information is often gathered through laboratory tests. Physicians can also use median survival rates depending on the stage. What these indicators really do, however, is determine what the cancer is doing, how the cancer is responding to treatment, and what the patient's health is. Prognosis is not a guarantee, in other words.