DiagnosisThe process of identifying a disease by its signs and symptoms. generally begins with tests
Myeloma is sometimes found following a routine blood test. However, more often than not, most people (70%) consult their healthcare professionals because of bone pain that’s not the result of a specific accident or incident. To determine the cause of the pain, an investigative test like an X-rayHigh-energy electromagnetic radiation used in low doses to diagnose diseases and in high doses to treat cancer., CT scan, or MRI is done. Multiple myeloma will be suspected if the test reveals fractures, bone lesions, or breaks.
Because the symptoms of myeloma are often vague and mirror symptoms that can be associated with other health issues, people suspected of having myeloma will usually be referred to a hematologistA doctor who specializes in the problems of blood and bone marrow. (blood specialist) for further tests so that a diagnosis can be confirmed.
Testing for myeloma
| Diagnostic testing | Prognostic testing | |
|---|---|---|
| Objectives | To determine if the person has myeloma, and if so, at which stageThe extent of a cancer in the body.. | To determine how aggressive the disease is and identify the best course of treatment. |
| When performed | When myeloma is suspected. | As required to assess the progression of the disease and the effectiveness of treatment. |
Below is a small sampling of tests that may be used to diagnose myeloma. Tests typically include those done on the blood, urine, and bone, along with various imaging and/or scans. In some cases, cardiac testing and FISH (Fluorescence in Situ Hybridization) analysis may also be conducted.
For a more exhaustive discussion on testing, download Myeloma Canada’s MGUS and Smouldering Multiple Myeloma InfoGuide.
- Complete blood countThe number of red blood cells, white blood cells, and platelets in a sample of blood. (CBCA common set of tests that measures the total or "absolute values" of red blood cells, white blood cells and platelets.) measures the numbers of different blood cellsMinute structures produced in the bone marrow; they include red blood cells, white blood cells, and platelets. such as red blood cells (RBCs), white blood cells (WBCs), platelets, and hemoglobin level.
- Blood chemistry measures total protein and calciumMineral found mainly in the hard part of bone. in the blood, as well as kidney function indicator.
- Other specialized blood tests confirm a myeloma diagnosis and assess disease progression.
- Urinalysis measures the amount of protein, free light chainsA portion of the monoclonal protein of light molecular weight that can be measured in a sensitive assay, the Freelite test. (from immunoglobulins), creatinineWaste product produced by the body that is broken down in the kidneys. (a waste product excreted by the kidneys), and bilirubin (a breakdown product of red blood cells) in a urine sample.
- 24-hour urine test measures the amount of protein in urine over a day.
- Other specialized urine tests help determine the disease stage and response to treatment.
Tests on your bone (bone marrowSpongy tissue that is found inside your bones. It is soft, fatty and full of blood vessels. Your bone marrow is where most of the blood cells in your body are made. aspirate/bone marrow biopsyThe removal of a sample of tissue for microscopic examination to aid in diagnosis.) may be conducted to determine the health of the bone marrow. Typically, a local anesthetic is applied to numb the area; you may also be given a short-acting sedative to minimize discomfort during the procedure.
For a bone marrow aspirate test, a needle is inserted into your bone, often the back pelvic bone, to extract a sample of liquid marrow. After this, a small core of marrow will be taken from the bone. This is the bone marrow biopsyRemoval of bone marrow tissue for examination under a microscope.. The procedure may leave you feeling bruised and you may ache for a few days afterwards, but generally this can be managed with mild painkillers. The bone marrow biopsy is usually an outpatient procedure and takes approximately 15–20 minutes.
For more information on how myeloma affects the bone, read Myeloma Canada’s Myeloma Bone Disease InfoGuide.
Different types of imaging may be necessary, depending on the results of your other tests. These may or may not include some of the following:
- Skeletal survey: Series of X-rays allowing the limbs, spine, skull, ribs, and pelvis (skeleton) bones to be seen.
- Whole-body low-dose computerized tomography (WBLDCT); often referred to as a whole-body CT scan: Scan that takes cross-section images of the body using low doses of radiation.
- Positron emission tomography (PET) scan: Imaging test that requires an injectionPushing a medication into the body with the use of a syringe and needle. of a liquid sugar with a radioactive label. Because myeloma cells absorb sugar faster than healthy cells, a specialized camera is able to see where the dye has been absorbed more. PET scans are often combined with computerized tomography (CT) scans.
- Magnetic resonance imaging (MRI): Uses magnetic fields and radio waves to produce 2-dimensional or 3-dimensional images of organs or structures in the body. MRIs can show where myeloma cells have infiltrated before any bone damage would be visible by X-ray. They can also identify amyloid/light chain deposits in the heart.
When undergoing treatment, some people may need to have monthly or even weekly tests done. At other times, tests may not be required for much longer periods of time.
There is no single schedule for testing. Each person’s situation needs to be assessed and treated individually depending on their condition.
Although myeloma is a blood cancerA term for diseases in which malignant cells divide without control. Cancer cells can invade nearby tissues and spread through the bloodstream and lymphatic system to other parts of the body., it can affect your bones as well.
Myeloma staging and classification
Once active multiple myeloma has been diagnosed, doctors will want to determine the level or stage of the disease.
The main system used to stage active myeloma is the Revised International StagingDoing exams and tests to learn the extent of the cancer in the body. System (R-ISS). The R-ISS uses 3 blood tests:
beta-2 microglobulin (β2M);
albuminSimple water-soluble protein found in the blood that can be increased in people with myeloma.;
lactate dehydrogenase (LDHLactate dehydrogenase, an enzyme that may be used to monitor myeloma activity.).
It also takes into consideration some high-risk chromosomal abnormalities you may have. The abnormalities can be detected by using a test called Fluorescent In Situ Hybridization (FISH) on a sample of purified plasma cellsSpecial white blood cells that produce antibodies. The malignant cell in myeloma. Normal plasma cells produce antibodies to fight infection. In myeloma, malignant plasma cells produce large amounts of abnormal antibodies that lack the capability to fight infection. The abnormal antibodies are the monoclonal protein, or M protein. Plasma cells also produce other chemicals that can cause organ and tissue damage (i.e. anemia, kidney damage and nerve damage). from your bone marrow.
High-risk chromosomal abnormalities are associated with more aggressive or harder to treat myeloma. Such abnormalities include:
del(17p): a deletion of the short arm of chromosomeA strand of DNA and proteins in the nucleus of a cell. Chromosomes carry genes and function in the transmission of genetic information. Normally, human cells contain 46 chromosomes. 17;
t(4;14): translocation of chromosomes 4 and 14;
t(14;16): translocation of chromosomes 14 and 16.
Although additional high-risk chromosomal abnormalities have been identified, they’re not used to calculate your R-ISS stage.
Revised International Staging System (R-ISS)
R-ISS Test
Beta-2 microglobulin (β2 M) is less than 3.5 mg/L
AND
Albumin is equal to or greater than 35 g/L
AND
No high-risk chromosomal abnormalities
AND
Normal lactate dehydrogenase (LDH) level
All possible combinations of R-ISS stages 1 and 3
Active myeloma is only staged at the time of diagnosis and the staging is usually not repeated. There are 3 possible stages— Stage 1, Stage 2, and Stage 3—and they are ordered by increasing disease severity.
For more information, download the Multiple Myeloma Patient Handbook
Designed to provide educational support to those living with myeloma, their caregivers, families, and friends, this handbook gives accurate, reliable, and clear information on myeloma. Among topics are in-depth discussions on what myeloma is, its causes and effects, treatment options in Canada, and how to manage your myeloma journey.