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.
How is multiple myeloma diagnosed?
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 and urine tests determine calcium levels and changes in abnormal proteins that multiple myeloma produces. In the blood, these proteins are called paraproteins. A test called serum protein electrophoresis (SPEP) measures paraproteins. In the urine, these proteins are called Bence-Jones proteins. They are measured by collecting a 24-hour urine sample and running a urine protein electrophoresis (UPEP).
A blood test called an immunofixation (IFE) test, may help find small traces of abnormal proteins. Immunoglobulins and light chains are checked in the blood; myeloma can make increased levels of these proteins. These tests are also followed in the blood to evaluate how the disease is responding to treatment.
Bone marrow aspiration and biopsy: For the majority of patients, myeloma is found in the bone marrow. Plasma cells that turn into cancer cells define myeloma and plasma cells normally reside in the bone marrow. This test not only informs whether someone has myeloma, but also provides information on how aggressive the cells are which helps with prognosis and appropriate treatment planning.
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, which may include:
- 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.
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.
Did You Know?
(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
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