How myeloma is diagnosed
Usually, you begin by seeing your family doctor (GP), who will examine you and arrange any blood tests or x-rays that may be necessary.
They will refer you to hospital for these tests and for specialist advice and treatment.
You’ll see a specialist called a haematologist, who specialises in conditions of the blood. They’ll ask about your general health and any previous medical problems. They’ll then examine you and arrange a series of tests including blood and urine tests, bone marrow biopsies and x-rays of the bones.
Blood tests are an important way to diagnose and monitor myeloma. Tests on your blood will include the following.
Serum protein electrophoresis
This is the main blood test used to diagnose myeloma. It measures the amount of abnormal antibodies (paraproteins) in the blood. This test is also used as a guide to see how well treatment is working.
Full blood count
This measures the levels of white blood cells, red blood cells and platelets in the blood. If any of the levels are low, this can show your doctor how your bone marrow has been affected by myeloma.
Urea and electrolytes (U&E) test
This test gives information on how well your kidneys are working.
This measures the level of calcium in the blood - it’s sometimes raised in myeloma.
Beta-2 microglobulin level
This measures the level of a protein produced by myeloma cells - it can help to tell how active a myeloma is.
This measures the level of albumin, a protein found in the blood - a low level of albumin can indicate an advanced myeloma.
Serum free light chain assays (Freelite®)
This test can detect light chains in the blood and is useful for diagnosing and monitoring light chain myeloma.
Urine samples may also be taken to test for the Bence Jones protein. You may need to take a container home and collect your urine for 24 hours. The nurses will explain more about how to do this test.
If there are paraproteins in your blood or urine, your doctor will want to take a sample of bone marrow (a biopsy). The biopsy is usually taken from the back of your hipbone (pelvis) or, sometimes, the breast bone. It’s then examined to see if it contains any myeloma cells.
The bone marrow sample is taken under a local anaesthetic. You’ll be given a small injection to numb the area. The doctor then gently passes a needle through your skin into the bone.
A small sample of liquid marrow is drawn into a syringe and looked at under a microscope (bone marrow aspiration).
The procedure can be done on the ward or in the outpatients department, and takes about 15–20 minutes. It can be uncomfortable when the marrow is drawn into the syringe, but this should only last for a very short time. You may be offered a short-acting sedative to reduce any pain or discomfort during the test.
The doctor will then take a small core of marrow from the bone (trephine biopsy). This procedure takes a few minutes longer. A special type of needle, which is a bit thicker than the one used for a bone marrow aspiration, is passed through the skin and bone into the bone marrow. The doctor will push the biopsy needle in and gently turn it back and forth. When the needle is withdrawn, it will contain a 1-2cm core of bone marrow.
You may feel bruised after having a sample of bone marrow taken, and have an ache for a few days. This can be eased with mild painkillers.
Each cell in the body contains chromosomes, which are made up of genes. Genes control all the cell’s activities. In myeloma, there may be changes in the structure of the chromosomes within the myeloma cells, but not in the normal cells of the body. Tests on the bone marrow samples will look for changes in the chromosomes.
These tests, known as cytogenetic tests, may help to decide on the best treatment and predict how well the myeloma may respond to that treatment. A test called fluorescence in situ hybridisation (FISH) is used to detect specific changes to the chromosomes of the myeloma cells.
X-rays will be taken to check for any possible damage to the bones from the myeloma cells (lytic lesions). You’ll usually have x-rays taken of your whole body, which is known as a skeletal survey and can take up to an hour. Although x-rays and scans aren’t painful, you may find lying on a hard surface for long periods of time uncomfortable. Ask your doctor, nurse or radiographer for a painkiller if you need one.