Multiple Myeloma

Testing & Diagnosis

Multiple myeloma can be difficult to diagnose because it may or may not show symptoms. Sometimes by the time symptoms arise, the disease has reached an advanced stage. If it is suspected that you have multiple myeloma, your doctor will likely order blood and urine tests, a bone marrow biopsy and imaging tests.

A definitive diagnosis of multiple myeloma requires (1) a very high proportion of plasma cells in the bone marrow, (2) biopsy results indicating a plasma cell tumor or (3) abnormal plasma cells making up 10 percent of the cells in the bone marrow, plus one of the following conditions:

  • Abnormally high level of monoclonal immunoglobulin, also known as the M protein
  • Anemia (low red blood cell count)
  • Hypercalcemia (increased blood calcium level)
  • Poor renal function
  • Abnormalities or holes in the bones or bone marrow found on an imaging test
  • An increase in one light chain (antibody protein) to a level 100 times that of the other light chains

Your doctor may also use these tests to help diagnose two related conditions: monoclonal gammopathy of undetermined significance (MGUS), a precancerous condition that may develop into multiple myeloma; and smoldering myeloma, an early myeloma that causes no signs or symptoms. Smoldering myeloma is also classified as asymptomatic multiple myeloma.

Blood and Urine Tests

Blood and urine laboratory tests are often ordered to check kidney function, calcium levels and hemoglobin levels (which can indicate anemia), and to look for the M protein antibody. At diagnosis, the M protein level helps your treatment team determine the presence and extent of the disease. During treatment, it helps monitor the treatment’s effectiveness.

Common blood and urine lab tests include the following.

24-hour urine protein test measures the levels of specific proteins in the urine over 24 hours. The presence of these proteins may indicate myeloma, and levels can indicate the extent of disease. Levels of other substances, such as creatinine, are also measured.

Beta-2-microglobulin is a protein in the blood made by cancer cells. A high level may indicate a large number of cancer cells.

Blood chemistry test includes measurements of the amounts of blood urea nitrogen (BUN), creatinine (Cr) and other substances in the blood. Higher levels of BUN and Cr can indicate impaired kidney function, which is common in people who have multiple myeloma.

Complete blood count (CBC) measures the levels of white blood cells, red blood cells (including hematocrit and hemoglobin levels) and platelets in the blood. Low counts could indicate the presence of excessive myeloma cells in the bone marrow.

Free light chain analysis measures a specific part of an antibody in the blood known as a light chain. The presence of light chains is associated with multiple myeloma, MGUS and amyloidosis (a rare disease caused by a buildup of abnormal proteins).

Immunofixation (IFE) test identifies and measures small amounts of abnormal protein in the blood (serum immunofixation) or in the urine (urine immunofixation).

Quantitative immunoglobulin test measures levels of different antibodies (also known as immunoglobulins) in the blood.

Serum protein electrophoresis measures the antibodies in the blood and can indicate the presence of the M protein created by myeloma cells.

Urine protein electrophoresis looks for an M-spike which occurs when M proteins are excreted by the kidneys into the urine.

Bone Marrow Biopsy and Aspiration

In addition to blood tests, your doctor may order a procedure, such as a bone marrow biopsy and/or bone marrow aspiration, in which a small amount of bone marrow is removed.

  • Bone marrow biopsy involves removing a sample of marrow from within the bone, usually from the pelvic bone.
  • Bone marrow aspiration involves removing liquid bone marrow.

The biopsy and aspiration are often done to collect multiple samples for examination. A pathologist (a doctor who specializes in the medical diagnosis of disease, including cancer) then examines the marrow under a microscope. Special testing may be done on the sample to check for chromosomal changes. Additionally, your doctor may order a biopsy of fat from around your stomach to check for amyloidosis.

Imaging Tests

Imaging tests are used to check for damage caused by multiple myeloma and to help determine the extent and spread of disease.

Computed tomography (CT) is done to look for tumors or abnormalities in soft tissues. CT, also called tomography or CAT, is a diagnostic procedure in which a scanner creates three-dimensional X-ray images of organs, tissues and bones inside the body and displays cross-sectional pictures of them on a computer screen. You will need to lie still on a table while the scan is being done. A special dye, called a contrast, may be injected into a vein or you may be asked to drink another type of dye. The dyes enhance the images and provide better detail.

Magnetic resonance imaging (MRI) uses magnetic fields instead of X-rays to visualize internal structures of the body. For an MRI, you will lie on a table that moves through a large circular scanner. As with CT, a special dye may be injected into a vein before the scan to enhance the images.

Positron emission tomography (PET) also creates images of organs and tissues, but the images are not as detailed as those from CT. PET images can be helpful in determining whether cancer has spread to the lymph nodes. A small amount of glucose (a sugar substance) containing radioactive atoms is injected into the body. Cancer cells, which use large amounts of energy, should absorb the sugar substance. A special camera is then used to show where the glucose has gathered. PET should be combined with CT, which is known as PET/CT.

X-rays use a low dose of radiation beams that create images of the inside of the body. These images may be used to look for bone damage.

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