Multiple Myeloma: Diagnosis
If your healthcare provider thinks you might have multiple myeloma, you will need certain exams and tests to be sure. Diagnosing multiple myeloma starts with your healthcare provider asking you questions. He or she will ask you about your health history, your symptoms, risk factors, and family history of disease. Your healthcare provider will also give you a physical exam.
What tests might I need?
You may have one or more of the following tests:
Bone marrow aspiration and biopsy
You’ll likely have blood tests done to look for signs of multiple myeloma. These tests might include:
Immunoglobulin (antibody) levels. Your healthcare provider will check the levels of different immunoglobulins (antibodies) in your blood. These are the proteins that your plasma cells make. In most cases, this cancer causes an increase in the level of a specific type of immunoglobulin.
Serum protein electrophoresis (SPEP) and serum immunofixation. These tests can be done on blood samples to check which type of immunoglobulin the cancer cells are making. This immunoglobulin is known as an M protein.
Complete blood count (CBC). This test checks the number of white and red blood cells and platelets in your blood. The cancer cells often crowd out the normal cells in the bone marrow, which is where new blood cells are made. This can lead to low levels of normal blood cells.
Blood chemistry tests. These tests check the levels of certain minerals and other chemicals in your blood. They can also give your healthcare provider an idea of how well your kidneys and liver are working.
Tests on a 24-hour urine sample. The immunoglobulins made by myeloma cells can often be detected in the urine. Your healthcare provider may ask you to collect all of your urine over a 24-hour period. He or she will then test it using urine protein electrophoresis (UPEP) and urine immunofixation.
Urinalysis. Having chemicals and proteins in your urine could mean you have problems with your kidneys. Your healthcare provider may check your urine for these markers.
Bone marrow aspiration and biopsy
These tests look for cancer cells in your bone marrow. First, your healthcare provider numbs the area over your hip with a local anesthetic. For the bone marrow aspiration, your healthcare provider places a thin, hollow needle attached to a syringe into your hip bone. This is done to suck out (aspirate) a sample of blood and cells from your bone marrow. This is normally followed by the bone marrow biopsy. For the biopsy, your healthcare provider uses a larger needle to remove a small piece of bone and bone marrow from your hip bone. Then, your healthcare provider looks at the bone marrow samples under a microscope to check for cancer cells. He or she may also do special lab tests on the samples. These can include immunohistochemistry (IHC), flow cytometry, cytogenetics (karyotyping), and fluorescent in situ hybridization (FISH).
Your healthcare provider may also do imaging tests to look for multiple myeloma. You may have one or more of these tests:
Bone X-rays (skeletal survey). Your healthcare provider may take X-rays of the bones in your body to look for signs of myeloma.
Magnetic resonance imaging (MRI). This test uses magnets and radio waves to create detailed images of the bone marrow and other organs. MRIs can show more detail than other imaging tests.
Computed tomography (CT) scan. A CT scan uses X-rays taken from many angles to create very detailed cross-sectional pictures of organs.
Positron emission tomography (PET) scan. For this test, your healthcare provider injects you with a slightly radioactive substance. This tends to collect in cancer cells. A special camera is then used to see which parts of your body have taken up more of the substance. The picture from a PET scan is not very detailed, but it can show likely areas of cancer throughout your body. Many machines can now do both a PET scan and CT scan at the same time. This is known as a PET/CT scan.
Getting your test results
When your healthcare provider has the results of your tests, he or she will contact you with the results. Your provider will talk with you about other tests you may need if multiple myeloma is found. Make sure you understand the results and what follow-up you need.
March 21, 2017
Clinical Features, Laboratory Manifestations, and Diagnosis of Multiple Myeloma. UpToDate.
Alteri, Rick, MD,Gersten, Todd, MD