How is Multiple Myeloma Diagnosed?

Various tests are conducted for the diagnosis of multiple myeloma since one result of a laboratory test cannot diagnose it alone. A number of factors like the history, complete body check-up, diagnostic test reports and symptoms of the patient are taken into consideration to get a proper diagnosis of multiple myeloma. Urine tests, blood tests and biopsy of the bone marrow are the first evaluations to assist in confirming multiple myeloma. Other tests like MRIs, PET scans, X-rays and CT scans can also be conducted.

The criteria for diagnosing myeloma determine the standards of diagnosing myeloma. This now needs the validation of one minor criterion and one main criterion, or three minor criteria in multiple myeloma patients showing myeloma symptoms. The criterion for diagnosing helps in the multiple myeloma classifications, whether it is symptomatic myeloma, MGUS or smoldering myeloma.

It is crucial that you have all the necessary tests for multiple myeloma since the results assist the doctor in determining the prognosis and options for treatment effectively. Majority of these tests also help in determining how the illness has progressed and in planning and observing treatment.

Since it is a rare type of cancer that, at first, shows few or no symptoms, multiple myeloma is hard to diagnose.

You will be examined by your doctor and questioned about any symptoms, your general health and your medical history. The doctor looks for aspects like tenderness of the bone, bleeding and signs of infection during the examination. To detect certain types of immunoglobulin (proteins and antibodies), blood and urine tests may be required.

You will be referred to a hematologist for more scans and tests, if multiple myeloma is suspected. If myeloma is in the early stages, you may be required to repeat the tests till a diagnosis is arrived at.

Blood Tests

Routine blood tests of multiple myeloma patients show abnormal levels of protein in the blood. Based on this, the doctor may do a physical exam to look for further symptoms. He will then suggest further tests.

Several blood tests are conducted to assist in diagnosing multiple myeloma, and to monitor the illness, they may be repeated. These tests include:

• PV (plasma viscosity) or ESR (erythrocyte sedimentation rate). The PV or ESR is normally increased if you suffer from multiple myeloma. 
• Serum viscosity  - This measures the thickness of the fluid portion of the blood.
• Free Light Chains. Ideally, there are two types of light chains in the blood in equal ratio. This test measures the levels of both the light chains and if the level of any one light chain is increased causing an imbalance in the ratio, it points to myeloma.
• Tests for quantifying the amount and nature of abnormal antibodies that are generated by the plasma cells that have cancer. This test is called Quantitative Immunoglobulins.
• Electrophoresis. Serum protein electrophoresis (SPEP) is a test to find monoclonalimmunoglobulin. Its presence itself points to multiple myeloma. This protein is also called M protein, M spike, and paraprotein.
• A FBC (full blood count). This blood test evaluates the red blood cells (RBC), white blood cells (WBC) and platelets in the blood. Low quantities of platelets and red blood cells are what your doctor will be looking for.
• Functionality of the kidney and the liver. Blood chemistry tests are conducted to calculate the blood urea nitrogen (BUN) and creatinine (Cr) levels. Higher levels are usually seen in persons having myeloma. It shows that the kidneys have been affected.
• The level of calcium in the blood. This too is measured by blood chemistry tests. High calcium levels in myeloma patients make them feel tired always.
• Albumin levels as measured by blood chemistry tests. Low levels of albumin points to advanced stage of myeloma.
• Levels of electrolytes.  Levels of major electrolytes like sodium and potassium could also be affected in patients suffering from myeloma. These levels too can be measured by blood chemistry tests.

Urine Tests

Abnormal proteins generated by the plasma cells that have cancer are checked during a urine test. It has been found that at times, the kidneys expel small amounts of M protein into the urine.  The abnormal proteins are termed as Bence Jones proteins or monoclonal light chains. The test conducted for finding these proteins is termed ‘urine protein electrophoresis’ (UPEP) and urine immunofixation.

These proteins damage the kidneys as they go, via them, from the blood to the urine. You may also be required to gather your urine in 24 hours’ time. This urine will be used to determine the amount of proteins that is being generated, and if your kidneys are functioning properly.

Other Tests

• X-rays and Other Types of Scans - X-rays will be conducted on your arms, legs, pelvis, spine and skull to check for any damage. X-rays generally help in showing the extent of bone damage, bone lesions, size and number of tumors in the bones. With the help of X-rays, doctors can make a diagnosis about the stage of myeloma and can also monitor their progress. Other types of scans, like MRI and CT scans, may also be conducted.
• MRI(Magnetic Resonance Imaging) - MRIs use strong radio waves and magnets. MRIs are more sensitive than X-rays in capturing images. This test is useful to monitor the extent of bone damage, particularly spinal cord lesions and the brain.
• CT Scans(Computed tomography) - CT scans produce detailed cross sectional images of the body. This helps the doctor to check bone tumors. It is also helpful in controlling a biopsy needle.
• Biopsy of the Bone Marrow - To confirm multiple myeloma, a biopsy of the bone marrow may be required. Generally, a large amount of plasma cells are found in the bone marrow of individuals suffering from multiple myeloma. A biopsy is a procedure used to examine the bone marrow. To take a small sample of the liquid bone marrow from one of the bones (normally the pelvis), a needle is used.This procedure is conducted with the use of a local anesthetic. Cancerous plasma cells will be checked for in the bone marrow.

Once the bone marrow biopsy and other tests confirm multiple myeloma diagnosis, treatment can follow based on the findings.