Diagnosing Multiple Myeloma

Multiple myeloma is hard to find early. Many patients don't have any symptoms until after their disease has reached an advanced stage. In some patients, the cancer causes symptoms that at first seem to be caused by something else. Rarely, the disease may be found in people without symptoms when a routine blood test shows a high amount of protein in the blood.

 

Symptoms of Multiple Myeloma
While some people don't have any symptoms at all, the following are the most common symptoms of this disease:

  • Bone problems
  • Low blood counts
  • High blood calcium
  • Nervous system symptoms
  • Kidney symptoms
  • Infections

 

Tests for Multiple Myeloma
Further testing will be done to determine the cause of your symptoms. No one test is enough to tell for sure if a person has multiple myeloma. Doctors look at all of these factors:

  • Symptoms
  • Physical exam
  • Results of blood tests, urine tests, and x-rays
  • Results of biopsies

Lab tests on the blood or urine, x-rays of the bones, and a bone marrow biopsy are usually done if there is concern that you might have multiple myeloma.

  • Blood Count
    The complete blood count (CBC) is a test that measures the levels of red cells, white cells, and platelets in the blood. If myeloma cells take up too much of the bone marrow, these levels will be low.
  • Blood Chemistry Tests
    Tests will be done to check the level of different chemicals and electrolytes (like calcium, potassium, and sodium) in the blood.
  • SPEP (serum protein electrophoresis)
     If your physician suspects myeloma this is one of the first tests that will be ordered.This test looks at the different proteins in the blood to see if the blood contains an abnormal myeloma protein.
  • Quantitative Immunoglobulins
    This test measures the blood levels of the different antibodies called immunoglobulins to see if any are too high or too low. In multiple myeloma, the level of one type may be high while the others are low. There are many other tests that can be done to measure antibodies, blood proteins, and urine proteins, too.
  • Beta-2 Microglobulin
    The level of this protein is elevated in multiple myeloma. It is used to predict outlook and also to monitor the results of treatment.
  • Bone Marrow Biopsy
    A bone marrow biopsy is done to take a sample of the bone marrow that can be examined under a microscope to see if there are myeloma cells present and if so, how many. This procedure can be done in a hospital setting or in a physician office.
  • Other Biopsy Tests
    In a fine needle aspiration (FNA) a very thin (fine) needle and a syringe are used to take out a small amount of tissue from a tumor or lymph node. The core needle biopsy is much like a FNA, but a larger needle is used and a larger tissue sample is removed. In multiple myeloma, these types of biopsies are most often used to check out abnormal areas that could be plasmacytomas.
  • Bone X-Rays
    Multiple myeloma causes bone damage that can be seen on x-rays. Your physician may order a series of x-rays that called a bone survey or skeletal survey.
  • CT (CAT) Scan
    A CT scan is another type of x-ray that gives a more detailed image of the body. CT scans can help to tell if your bones have been damaged by myeloma. They can also be used to guide a biopsy needle into a tumor.
  • MRI (magnetic resonance imaging)
    This test uses radio waves and strong magnets instead of x-rays to take pictures. A computer translates the pattern of radio waves into cross-sectional pictures of the body. MRI scans are very helpful in looking at bones, the brain, and the spinal cord. They may be able to find plasmacytomas that cannot be seen on regular x-rays. MRI scans can also be used to look at the bone marrow in patients with multiple myeloma.
  • PET Scan (positron emission tomography)
    For a PET scan, a type of radioactive sugar (glucose) is put into one of your veins. Cancer cells absorb high amounts of this sugar. A special camera can then spot the radioactivity. When a patient appears to have a solitary plasmacytoma, a PET scan may be used to look for other plasmacytomas.