Multiple Myeloma Diagnosis
If you have symptoms that may signal multiple myeloma, your doctor will examine you and ask you questions about your health and your medical history. One or more of the following tests may be used to diagnose multiple myeloma. These tests also may be used to find out if treatment is working. One or more of the following tests may be used to find out if you have multiple myeloma. These tests also may be used to find out if treatment is working.
Blood tests
A blood test called serum protein electrophoresis (SPEP) can be used to detect paraproteins (m proteins) in the blood. These are the abnormal proteins produced by cancerous plasma cells. Other tests can be used to assess blood calcium levels.
Urine tests
Your doctor may collect a 24-hour urine sample and run a urine protein electrophoresis (UPEP) test to detect the presence of Bence Jones proteins, the abnormal protein produced by cancerous plasma cells.
Bone marrow aspiration and biopsy
For the majority of patients, myeloma is found in the bone marrow. Using a long needle, your doctor will aspirate (remove) a small amount of your bone marrow to examine in a laboratory. This is called a bone marrow biopsy. Looking at your bone marrow under a microscope can help your doctor determine if cancerous cells are present. This also provides information on how aggressive the cells are which helps with prognosis and appropriate treatment planning.
Tumor biopsy
Multiple myeloma can cause tumors called plasmacytomas in the bone or soft tissue around the bone. These tumors may be biopsied, or surgically removed and examined under a microscope for the presence of cancer cells.
Imaging tests
These imaging tests may include:
- X-rays
- PET (positron emission tomography) scans
- MRI (magnetic resonance imaging) scans
- Bone density scan
- CT or CAT (computed axial tomography) scans
These tests may not be performed in all cases. However, they can help your doctor detect complications associated with multiple myeloma, like bone lesions, and also determine if cancer has spread.
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Multiple Myeloma Staging
If you are diagnosed with multiple myeloma, your doctor will determine the stage of the disease. Staging is a way of determining how much disease is in the body and where it has spread, and informs prognosis. Stage 1 indicates less aggressive myeloma, while Stage 3 describes the most aggressive forms. This information helps the doctor plan the best treatment. Once the staging classification is determined, it stays the same even if treatment is successful or the cancer spreads.
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Multiple Myeloma Stages
(source: Cancer Network)
The Revised International Staging System (R-ISS) is used to determine the stage of multiple myeloma. It is based on two blood tests, the serum albumin and the serum Beta 2 microglobulin (β2M).
Stage 1 Multiple Myeloma: serum beta-2 microglobulin <3.5 mg/L, serum albumin level of 3.5 g/dL or greater, normal LDH level and no high risk chromosomal abnormalities (i.e. deletion 17p, translocation (4;14) or translocation (14;16))
Stage 2 Multiple Myeloma: serum beta-2 microglobulin >3.5 mg/L but less than 5.5 mg/L, and/or serum albumin level < 3.5 g/dL, normal LDH level and no high risk chromosomal abnormalities (i.e. deletion 17p, translocation (4;14) or translocation (14;16))
Stage 3 Multiple Myeloma: serum beta-2 microglobulin > 5.5 mg/L and either high risk chromosomal abnormalities (i.e. deletion 17p, translocation (4;14) or translocation (14;16)) or high LDH level