Testing for Multiple Myeloma: Getting a Diagnosis

Multiple myeloma is a rare blood cancer that develops in plasma cells (white blood cells) that help fight infection by producing antibodies. Multiple myeloma begins in the plasma cells of the bone marrow.

People with multiple myeloma have high levels of certain proteins in their blood and urine. An oncologist (a doctor who specializes in diagnosing and treating cancer) will test and diagnose multiple myeloma.

Here are diagnostic steps you can take if your doctor suspects you have multiple myeloma:

Multiple myeloma causes changes in blood cells that can lead to physical signs and symptoms. When you see your doctor, he will likely ask about your symptoms and when they started.

They may ask about possible symptoms of multiple myeloma you may have, including:

• Fatigue
• Weakness
• Dyspnea
• Bleeding
• Bruises
• Frequent infections
• Bone fractures
• Dizziness

They may also ask about symptoms associated with complications of multiple myeloma. Thirst, increased urination and constipation may be signs of hypercalcemia (too much calcium in the blood), a complication of multiple myeloma. Swelling and itching of the legs are potential signs of kidney damage caused by multiple myeloma.

Your doctor will probably also ask about your medical history.

After reviewing your symptoms and medical history, your doctor will likely perform a physical examination, paying special attention to any areas of bleeding or bruising. They may also evaluate for fractures or broken bones, since multiple myeloma cancer cells can weaken bones, increasing the risk of bone fractures.

Multiple myeloma affects the health of several types of blood cells. Your blood may show signs of multiple myeloma, such as abnormal levels of specific proteins or antibodies.

Blood tests that health care providers use to diagnose multiple myeloma include:

• Complete blood count (CBC): A complete blood count (CBC) measures the levels of red blood cells, white blood cells, and platelets in the blood. Most people with multiple myeloma have anemia (low levels of red blood cells).
• Tests for blood urea nitrogen (BUN) and creatinine: These tests determine how well your kidneys are working, since multiple myeloma often affects the kidneys.
• Albumin test: Albumin is a protein whose levels may be low in people with multiple myeloma.
• Calcium test: People with multiple myeloma usually have high calcium levels because the cancer affects the bones.
• Quantitative immunoglobulins: This test measures the level of antibodies in the blood. People with multiple myeloma may have increased production of certain antibodies.
• Electrophoresis: This test measures levels of monoclonal (M) protein, an antibody protein produced by myeloma cells. Your M protein level can show whether you have multiple myeloma or a related disease.

Multiple myeloma can damage the kidneys, causing high levels of protein in the urine. To check for signs of kidney damage and multiple myeloma, your healthcare provider may ask you to collect all your urine for 24 hours. They will then send a 24 hour sample. to the laboratory for testing.

A biopsy involves taking a sample of body tissue and sending it to a laboratory for testing. To diagnose multiple myeloma, your doctor will take a bone marrow sample.

Bone marrow is the soft, spongy tissue in the center of bones. This is where blood cells are produced. Multiple myeloma starts in plasma cells in the bone marrow, and people with multiple myeloma have too many plasma cells.

During bone marrow biopsyYour doctor will take a bone marrow sample with a hollow needle, usually from the inside of your thighbone. The sample will then be examined under a microscope in a laboratory to determine the presence of cancer cells.

They may also want to check the liquid part of the bone marrow, called an aspirate. There are several tests they can do on the aspirate to confirm whether there are cancer cells in it.

Imaging tests take pictures of tissue inside your body. This can help your healthcare team determine whether you have multiple myeloma and how far it has spread throughout your body. Imaging tests used to diagnose multiple myeloma may include:

• x-ray: A bone X-ray can help your doctor determine whether myeloma cells have damaged your bones and how severe the damage is.
• Computed tomography (CT): This test uses multiple x-rays to create images of your body. This can help determine if your bones are weak or damaged.
• Magnetic resonance imaging (MRI): This test uses radio waves and magnets to create images of the soft tissues of your body. This can help assess the health of your bone marrow.
• Positron emission tomography (PET): A PET scan can help detect cancer cells and determine their location in the body. Radioactive glucose (sugar) is injected into the blood. Because cancer cells absorb large amounts of sugar, they also absorb radioactive material. A special camera can create images of these cells, showing any cancer cells that have absorbed radioactive material.

When a person is diagnosed with multiple myeloma, their medical team performs additional tests to determine the stage of the cancer. Staging is important for developing an effective treatment plan and an accurate prognosis (prognosis of the disease).

Health care providers use the Revised International Staging System (RISS) to determine the stage of multiple myeloma. This system is based on the amount of certain cells and substances in the blood.

The multiple stages of myeloma include:

• Stage 1: You have high levels of the protein albumin and low levels of an antibody called serum beta-2 microglobulin in your blood.
• Stage 2: Your blood levels do not meet the criteria for stage 1 or stage 3.
• Stage 3: You have high levels of beta-2-microglobulin in your serum and high levels of an enzyme called lactate dehydrogenase (LDH) in your blood, as well as abnormal chromosomes in your cancer cells.

In addition to the stage of cancer, there are other factors that influence a person's condition. prognosis for multiple myeloma include their age, kidney function and general health.

Other chronic diseases can cause changes in your plasma cells. These conditions can cause symptoms similar to those of multiple myeloma, but they are not considered cancer. A healthcare professional may have to rule this out before diagnosing you with multiple myeloma.

Other plasma cell disorders they may check for include:

• Monoclonal gammopathy of undetermined significance. (MGUS): This condition occurs when your plasma cells make too many copies of the same antibody. People with MGUS have high levels of M protein in their blood, but normal levels of blood cells and calcium. They also have healthy kidney function. MGUS often does not cause any symptoms.
• Smoldering multiple myeloma (SMM): This early, inactive form of multiple myeloma does not cause any symptoms and is usually detected with a blood test. In some people, it can progress to active multiple myeloma.
• Solitary plasmacytoma: This single plasma cell tumor usually develops in the bone. It can be diagnosed using imaging tests and biopsy.
• Light chain amyloidosis: This condition causes abnormal growth of plasma cells. This can cause damage to certain organs such as the heart and kidneys. It is often diagnosed by biopsy.

Multiple myeloma is a rare blood cancer that develops in plasma cells in the bone marrow. If your doctor suspects you have multiple myeloma, he or she will likely refer you to an oncologist for evaluation.

Diagnostic tests for multiple myeloma may include blood tests, urine tests, and imaging tests, as well as a biopsy. Multiple myeloma can cause high calcium levels and low red blood cell levels, poor kidney health, and weak bones. Diagnostic tests can help detect these and other signs of multiple myeloma.