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Health Line
6 hours ago
- Health
- Health Line
Understanding the Stages of Multiple Myeloma
Key takeaways Multiple myeloma is a cancer of the blood that affects plasma cells, and its progression is determined using the Durie-Salmon Staging System or the Revised International Staging System (RISS). The stages of multiple myeloma range from 0 to 3, with higher stages indicating that the cancer has spread and will likely require more intensive treatment. Treatments for multiple myeloma include drug therapies, radiation, and stem cell transplants. Multiple myeloma is a blood cancer that forms in the white blood cells produced by bone marrow. Doctors stage multiple myeloma based on the levels of proteins produced by cancerous cells found throughout the body and other clinical factors affected by cancer. A higher stage means that the cancer has progressed and spread (metastasized). Typically, a higher stage, like stage 3, also causes more symptoms and requires more aggressive treatment. What is multiple myeloma? Multiple myeloma is a type of blood cancer that forms in plasma cells. Plasma cells are a type of white blood cell. Healthy plasma cells are an important part of the immune system and help the body fight infections. When multiple myeloma develops, cancerous plasma cells form. These plasma cells don't help your body fight infection. Over time, these cells multiply and overwhelm your healthy plasma cells. How is multiple myeloma diagnosed and staged? Tests such as bloodwork can help detect multiple myeloma. Blood tests can show the presence of proteins made by cancerous plasma cells. If your doctor suspects multiple myeloma, you might also be asked to do a bone marrow biopsy since plasma cells are produced in your bone marrow. Sometimes, imaging tests such as X-rays or MRIs are done to look for bone damage and other signs of multiple myeloma. Multiple myeloma is staged using the Durie-Salmon Staging System or the Revised International Staging System (RISS). Durie-Salmon Stage System stages of multiple myeloma The Durie-Salmon Stage System assigns stages by looking at: level of kidney function level of blood calcium hemoglobin concentration amount of M protein in blood and urine presence of bone lesions in imaging studies Stage Criteria I • hemoglobin level > 10 g/dL • serum calcium level < 10.5 mg/dL • a normal bone structure or solitary bone plasmacytoma assessed with conventional radiography • low rate of M-component production (IgG level < 5 g/dL; IgA level < 3 g/dL • Bence Jones protein level < 4 g/24 h II Neither stage I nor stage III III One or more of the following: • hemoglobin value < 8.5 mg/dL • serum calcium level > 12.5 mg/dL • advanced lytic bone lesions assessed with conventional radiography • high M-component production rate (IgG value > 7g/dL; IgA value > 5 g/dL; Bence Jones protein > 12 g/24 h) RISS stages of multiple myeloma The RISS assigns stages by looking at: amount of albumin in blood amount of LDH in blood amount of beta-2 microglobulin in blood gene abnormalities of multiple myeloma Below we break down the RISS stages for multiple myeloma and their treatments: Stage 0 multiple myeloma Stage 0 is sometimes called smoldering multiple myeloma or asymptomatic multiple myeloma. At this stage, there are often no symptoms. Clinical criteria for Stage 0 include: blood counts, calcium levels, and kidney function are all normal no bone or organ damage no evidence of amyloid protein buildup serum monoclonal protein greater than or equal to 30 g/L, urinary monoclonal protein greater than or equal to 500 mg per 24 hours, or clonal bone marrow plasma cells 10–60% Stage 0 multiple myeloma treatment Treatment isn't typically needed at this stage. Instead, careful monitoring and regular testing are used to watch for progression. Stage 1 multiple myeloma Multiple myeloma needs to meet certain criteria. This includes: albumin levels greater or equal to 3.5 g/dL serum beta-2 microglobulin less than 3.5 mg/L cytogenetics that are not classed 'high risk' normal LDH levels You might notice symptoms such as bone pain and weakness in your arms and legs at this stage. Stage 1 multiple myeloma treatment Drug therapies are the primary treatment for multiple myeloma. These therapies aim at destroying multiple myeloma cells and include options such as: proteasome inhibitors chemotherapy steroids antibodies immunomodulatory drugs (IMiDs) b-cell maturation antigen (BCMA)-targeted therapies A treatment plan for stage 1 multiple myeloma might include one or a combination of these drug therapies. You might also have treatments such as radiation therapy or a stem cell transplant, depending on your individual treatment plan. Stage 2 multiple myeloma Stage 2 multiple myeloma needs to meet certain criteria. This includes: beta-2 microglobulin between 3.5 mg/L and 5.5 mg/L cytogenetics are either not high risk or have a risk level that is undefined it's not stage 1 or stage 3 By stage 2, symptoms might be more advanced, including loss of appetite or stomach pain. Stage 2 multiple myeloma treatment Treatment options in stage 2 are the same as the treatment options in stage 1. Drug therapies can be used alone or in combination with options such as radiation therapy or a stem cell transplant. In stage 2, higher doses or more potent drugs might be used. Stage 3 multiple myeloma Stage 3 is the most advanced stage of multiple myeloma. To be classed stage 3, multiple myeloma needs to meet these criteria: cytogenetics are considered high risk serum beta-2 microglobulin equal or greater to 5.5 mg/L high levels of LDH Stage 3 multiple myeloma treatment Treatment by stage 3 is more aggressive to slow and stop the cancer from spreading further. Additional treatments with drug therapies are typically still part of treatment plans. A stem cell transplant might also be an option. You and your team can discuss if this is an option for you. RISS stages for multiple myeloma Bottom line Multiple myeloma is a blood cancer that affects plasma cells. Doctors use certain staging systems to discuss how far multiple myeloma has spread. As multiple myeloma advances, stages increase from 1 to 3. Often, later stages require more aggressive treatment.
Health Line
6 hours ago
- Health
- Health Line
Understanding the Stages of Thyroid Cancer
Key takeaways Thyroid cancer staging helps doctors determine the best treatment and predict the likely outcome. It uses the American Joint Committee on Cancer (AJCC)'s TNM system, which assesses tumor size, lymph node involvement, and metastasis. Staging differs among the main types of thyroid cancer, including medullary, follicular, papillary, and anaplastic. Anaplastic thyroid cancer is aggressive and is always stage IV. Early stage cancers generally have better treatment outcomes and survival rates. The American Cancer Society estimates that about 43,800 people in the United States will be diagnosed with thyroid cancer by the end of 2022. Women are affected three times more often than men. Doctors stage thyroid cancer from stage I to stage IV depending on how far along your cancer has progressed. Different staging systems are used for different types of thyroid cancer. Keep reading to learn more about how the most common types of thyroid cancer are staged. How is the staging for thyroid cancer determined? Thyroid cancer is most often staged using the American Joint Committee on Cancer (AJCC) TNM staging system. This staging system considers: T: How big the tumor is and whether it has spread to nearby tissues. N: Whether the cancer has spread into nearby lymph nodes. M: Whether the cancer has metastasized, meaning spread to distant tissues. The AJCC staging system differs depending on which type of thyroid cancer you have. The four main types are: Medullary thyroid cancer: Develops in special cells called C cells that produce the hormone calcitonin. Follicular thyroid cancer: A usually slow-growing cancer that develops in follicular cells. These cells produce and secrete triiodothyronine (T3) and thyroxine (T4). Papillary thyroid cancer: Develops in follicular cells and makes up 80% to 85% of thyroid cancers. It generally has the best outlook. Anaplastic thyroid cancer: Makes up less than 2% of thyroid cancers but is the most aggressive type. It develops in follicular cells. Knowing which stage you're in helps doctors figure out what the best treatment option may be. It can also give you and your healthcare team the best idea of what to expect in terms of life expectancy and chances of being cured. Staging for medullary thyroid cancer The overall 5-year relative survival rate for medullary thyroid cancer is nearly 100% if it's limited to your thyroid and 89% for all stages combined. The 5-year relative survival rate is a measure of how many people with the cancer are alive 5 years later compared to people without the cancer. Here's a look at the AJCC's TNM system for medullary thyroid cancer: Stage TNM groups Description I T1 N0 M0 T1: The cancer is smaller than 0.8 inches across and only found in the thyroid. N0: It has not spread to nearby lymph nodes. M0: It has not spread to distant body parts. II T2 N0 M0 T2: The cancer is bigger than 0.8 inches but smaller than 1.6 inches across. It's only found in the thyroid. N0: It has not spread to nearby lymph nodes. M0: It has not spread to distant body parts. OR II T3 N0 M0 T3: The cancer is larger than 1.6 inches across and is limited to the thyroid or has grown outside the thyroid but hasn't spread to nearby tissues. N0: It has not spread to nearby lymph nodes. M0: It has not spread to distant body parts. III T1, T2, or T3 N1a M0 T1 to T3: The cancer can be any size but hasn't invaded tissues around your thyroid. N1a: The cancer has spread to lymph nodes in your neck. M0: The cancer hasn't spread to any distant body parts. IVA T4a Any N M0 T4a: The cancer is any size and has grown into nearby tissues such as your windpipe or voice box. Any N: It may or may not have spread to nearby lymph nodes. M0: It hasn't spread to distant body parts. OR IVA T1, T2, or T3 N1b M0 T1 to T3: The cancer is any size and may have grown outside the thyroid. It hasn't grown into any nearby structures. N1b: The cancer has spread to lymph nodes in your neck. M0: The cancer has not spread to distant body parts. IVB T4b Any N M0 T4b: The cancer is any size and has either grown toward your spine or into major blood vessels nearby. Any N: The cancer may or may not have spread to lymph nodes. M0: The cancer has not spread to distant body parts. IVC Any T Any N M1 Any T: The cancer is any size and may have grown into nearby structures. Any N: The cancer may or may not have spread into lymph nodes. M1: The cancer has spread into distant areas such as your liver, brain, or bone. Staging for differentiated (papillary and follicular) thyroid cancer Staging for papillary or follicular thyroid cancer depends on whether you're over or under the age of 55. The overall 5-year relative survival rate for people with papillary thyroid cancer is nearly 100% and about 98% for follicular cancer. Stage Age of diagnos is TNM groups Description I younger than 55 years Any T Any N M0 Any T: The cancer is any size. Any N: The cancer may or may not have spread to lymph nodes. MO: It hasn't spread to distant areas. OR I 55 years or older T1 N0 or NX M0 T1: The cancer is smaller than 0.8 inches across and is only found in your thyroid gland. N0 or NX: The cancer hasn't spread to nearby lymph nodes or there isn't enough information to assess if the cancer has spread to lymph nodes. M0: The cancer hasn't spread to distant areas. OR I 55 years or older T2 N0 or NX M0 T2: The cancer is larger than 0.8 inches across but smaller than 1.6 inches. It's limited to your thyroid. N0 or NX: The cancer hasn't spread to nearby lymph nodes or there isn't enough information to assess if the cancer has spread to lymph nodes. M0: The cancer hasn't spread to distant areas. II younger than 55 years Any T Any N M1 Any T: The cancer is any size. Any N: The cancer may or may not have spread to nearby lymph nodes. M1: The cancer has spread to distant body parts like your bone or internal organs. OR II 55 years or older T1 N1 M0 T1: The cancer is smaller than 0.8 inches across and limited to the thyroid. N1: The cancer has spread to nearby lymph nodes. M0: The cancer hasn't spread to distant areas. OR II 55 years or older T2 N1 M0 T2: The cancer is larger than 0.8 inches across but smaller than 1.6 inches. It's limited to your thyroid. N1: The cancer has spread to nearby lymph nodes. M0: The cancer hasn't spread to nearby areas. OR II 55 years or older T3a or T3b Any N M0 T3a or T3b: The cancer is larger than 1.6 inches across but limited to the thyroid or the muscles that support your thyroid. Any N: The cancer may or may not have spread into nearby lymph nodes. M0: The cancer hasn't spread to distant sites. III 55 years or older T4a Any N M0 T4a: The cancer is any size and has grown beyond your thyroid into surrounding tissues such as your voice box or windpipe. Any N: The cancer may or may not have spread into nearby lymph nodes. M0: The cancer hasn't spread to distant sites. IVA 55 years or older T4b Any N M0 T4b: The cancer has spread extensively beyond your thyroid toward your spine or into large blood vessels in the surrounding area. Any N: The cancer may or may not have spread into nearby lymph nodes. M0: The cancer has not spread to distant locations. IVB 55 years or older Any T Any N M1 Any T: The cancer is any size. Any N: The cancer may or may not have spread to nearby lymph nodes. M1: The cancer has spread to distant parts of your body. Staging for undifferentiated (anaplastic) thyroid cancer Anaplastic cancer has the poorest outlook of any thyroid cancer. Its 5-year relative survival rate is 7%. All anaplastic cancers are considered to be stage IV. It's divided into substages depending on its features. Stage Stage grouping Description IVA T1, T2 or T3a N0 or NX M0 T1, T2, or T3a: The cancer can be any size as long as it's contained to your thyroid. N0 or NX: The cancer hasn't spread to nearby lymph nodes or there's not enough information to know if it has. M0: The cancer has not spread to distant parts of your body. IVB T1, T2 or T3a N1 M0 T1, T2, or T3a: The cancer can be any size as long as it's contained to your thyroid. N1: The cancer has spread to nearby lymph nodes. M0: The cancer has not spread to distant parts of your body. OR IVB T3b Any N M0 T3b: The cancer is any size and has grown into the muscles that support your thyroid. Any N: The cancer may or may not have spread into nearby lymph nodes. M0: The cancer has not spread to distant parts of your body. OR T4 Any N M0 T4: The cancer has grown beyond the thyroid gland and into nearby tissue such as your voice box or windpipe. It also may have grown toward your spine or large blood vessels nearby. Any N: The cancer may or may not have spread to nearby lymph nodes. M0: The cancer has not spread to distant parts of your body. IVC Any T Any N M1 Any T: The cancer can be any size. Any N: The cancer may or may not have spread to nearby lymph nodes. M1: The cancer has spread into distant body parts such as your bones or internal organs. Takeaway Thyroid cancer is broken into stages depending on how far the cancer has progressed. The AJCC's TNM staging for papillary or follicular thyroid cancer also considers your age. Cancers in early stages are considered easier to treat and have a better outlook. Due to the aggressive nature of anaplastic thyroid cancer, it's always considered stage IV. Knowing what stage of cancer you're in helps doctors understand how to best manage your cancer. It can also give you an idea of your chances of survival. Survival statistics are often based on old data, so your chances of survival might be better than statistics suggest.
Leader Live
18 hours ago
- Entertainment
- Leader Live
Actor John Middleton to join cast of Hollyoaks
Middleton will play the character of Froggy, who is the grandfather of Clare Devine, Rex Gallagher and Grace Black. Froggy, also known as Notorious Froggy or Fraser Black Senior, is currently residing in Longmere Prison but is soon to be released with plans to leave his criminal past behind. In prison he has befriended long-term character and fellow inmate Tom Cunningham, with the pair working to together to conspire against Clare Devine. Middleton, who starred in ITV's Emmerdale as Ashley Thomas from 1996 to 2017, said: 'From vicar to villain is quite a leap but that's why I love this part. 'Froggy has a very dark history and he could reveal everyone's murky past. He knows where all the bodies are buried; perhaps quite literally…' Middleton's previous TV credits include Cracker, Heartbeat, Doctors, Hetty Wainthropp Investigates, and The Ruth Rendell Mysteries, and played Colonel Pickering in the UK Tour of My Fair Lady throughout 2022 and 2023. Hollyoaks is available to stream from 7am on Monday to Wednesday on Channel 4 or to watch live on E4 at 7pm.
South Wales Guardian
a day ago
- Entertainment
- South Wales Guardian
Actor John Middleton to join cast of Hollyoaks
Middleton will play the character of Froggy, who is the grandfather of Clare Devine, Rex Gallagher and Grace Black. Froggy, also known as Notorious Froggy or Fraser Black Senior, is currently residing in Longmere Prison but is soon to be released with plans to leave his criminal past behind. In prison he has befriended long-term character and fellow inmate Tom Cunningham, with the pair working to together to conspire against Clare Devine. Middleton, who starred in ITV's Emmerdale as Ashley Thomas from 1996 to 2017, said: 'From vicar to villain is quite a leap but that's why I love this part. 'Froggy has a very dark history and he could reveal everyone's murky past. He knows where all the bodies are buried; perhaps quite literally…' Middleton's previous TV credits include Cracker, Heartbeat, Doctors, Hetty Wainthropp Investigates, and The Ruth Rendell Mysteries, and played Colonel Pickering in the UK Tour of My Fair Lady throughout 2022 and 2023. Hollyoaks is available to stream from 7am on Monday to Wednesday on Channel 4 or to watch live on E4 at 7pm.
RTÉ News
a day ago
- Entertainment
- RTÉ News
Emmerdale star John Middleton to join cast of Hollyoaks
Actor John Middleton, known for his long-running role as vicar Ashley Thomas on Emmerdale, is to join the cast of Hollyoaks as a series regular, it has been announced. Middleton will play the character of Froggy, who is the grandfather of Clare Devine, Rex Gallagher and Grace Black. Froggy, also known as Notorious Froggy or Fraser Black Senior, is currently residing in Longmere Prison but is soon to be released with plans to leave his criminal past behind. In prison he has befriended long-term character and fellow inmate Tom Cunningham, with the pair working to together to conspire against Clare Devine. Middleton, who starred in ITV's Emmerdale as Ashley Thomas from 1996 to 2017, said: "From vicar to villain is quite a leap but that's why I love this part. "Froggy has a very dark history and he could reveal everyone's murky past. He knows where all the bodies are buried; perhaps quite literally…" Middleton's previous TV credits include Cracker, Heartbeat, Doctors, Hetty Wainthropp Investigates, and The Ruth Rendell Mysteries, and played Colonel Pickering in the UK Tour of My Fair Lady throughout 2022 and 2023.
