Multiple Myeloma Diagnosis

The myeloma cells build up in the bone marrow, forming tumors in many bones of the body and preventing the bone marrow from creating healthy blood cells that your body needs to function properly.

A multiple myeloma diagnosis often results from routine blood tests for other conditions. It can be difficult to confirm on the basis of any single lab test. Winship’s approach to diagnosing multiple myeloma involves a complete assessment of a patient’s signs and symptoms, medical history, physical evaluation and various multiple myeloma diagnostic tests.

People with multiple myeloma typically feel signs and symptoms only when the cancer has progressed to a late stage. They can be very vague and difficult to detect early. Some of these signs and symptoms can include:

• Low blood count (anemia)
• Extreme fatigue
• Muscle weakness
• Bone problems and/or pain
• Sudden, severe back pain
• Increase in infections

With each passing year, multiple myeloma diagnostic tests become more advanced and capable of earlier detection. At Winship, experts use a set of multiple myeloma diagnostic criteria to reach a diagnosis. Multiple myeloma tests and procedures can include:

• Blood tests. These include a complete blood count (CBC) and blood chemistry tests. A CBC measures the red blood cells, white blood cells and platelets in the blood. A blood chemistry test measures the levels of creatinine, albumin, calcium and other electrolytes in the blood.
• Quantitative immunoglobulins. This is a blood test for multiple myeloma that measures immunoglobulins, or antibodies, that are present in the blood. These include IgA, IgD, IgE, IgG and IgM. If any of these antibodies is abnormally high, it could be an indicator of multiple myeloma.
• Urine test. A urine sample can be helpful to detect the amount of myeloma protein that has been filtered by the kidneys.
• Electrophoresis. Another blood test for multiple myeloma that detects monoclonal antibodies, an indicator that multiple myeloma may be present.
• Bone marrow biopsy. A bone marrow biopsy extracts a tissue sample of bone marrow to test it for high levels of plasma cells. The sample is then analyzed by a bone marrow specialist.
• Advanced imaging tests. Imaging tests use a variety of advanced techniques (sound waves, X-rays, magnetic fields and radioactive substances) to create detailed images of the inside of your body. These include:
  • Bone X-rays: Often called a bone survey, these X-rays can look at whether the bone has been damaged by myeloma cells.
  • Computed tomography (CT): CT scans can show whether multiple myeloma has damaged the bone.
  • Magnetic resonance imaging (MRI): MRI can be used to look at a patient’s bone marrow.
  • Positron emission tomography (PET): This type of imaging test injects a patient with a form of radioactive sugar that is absorbed by cancer cells. A special camera is then used to detect the cancer. PET scans are often combined with CT scans.

According to the American Cancer Society (ACS), a confirmed multiple myeloma diagnosis needs the following:

• Presence of a plasma cell tumor (which can be proven with a bone marrow biopsy) or at least 10% of plasma cells found in the bone marrow AND
• At least one of the following:
  • High levels of calcium in the blood
  • Poor kidney function
  • Low red blood cell counts (anemia)
  • Holes in the bones found on imaging scans (CT, MRI, PET scan)
  • Increase in one type of light chain in the blood
  • 60% or more plasma cells in the bone marrow