How myeloma is diagnosed

Myeloma can be diagnosed in different ways. Some people will first see a family doctor (GP) about symptoms such as pain, tiredness or infections. Other people are diagnosed with myeloma after being admitted to hospital with more severe symptoms, such as spinal cord compression or kidney problems.

At the hospital, you’ll usually see a doctor called a haematologist, who specialises in conditions of the blood. The haematologist will arrange tests, including:

  • Blood tests – These are an important way to diagnose and monitor myeloma.
  • Urine tests – You may be asked to give urine samples to test for Bence Jones protein. These tests can also show how well your kidneys are working.
  • A bone marrow biopsy - If there is a paraprotein in your blood or urine, a doctor or nurse will take a sample (biopsy) of bone marrow. The sample is sent to a laboratory to be checked under a microscope for abnormal cells.
  • X-rays – X-rays will be taken to check for any damage to the bones from myeloma cells (lytic lesions).

How myeloma is diagnosed

Myeloma can be diagnosed in different ways. Some people will first see a family doctor (GP) about symptoms such as pain, tiredness or infections. The GP will examine them and arrange for some blood tests or x-rays. The GP can then make a referral to a specialist at the hospital for more tests and treatment if necessary.

Other people are diagnosed with myeloma after being admitted to hospital with more severe symptoms such as spinal cord compression or kidney problems.

At the hospital

You’ll usually see a doctor called a haematologist, who specialises in conditions of the blood. They will ask about your general health and any previous medical problems. They will then examine you and arrange more tests, including:

  • blood tests
  • urine tests
  • a bone marrow biopsy
  • x-rays of your bones.


Blood tests

Blood tests are an important way to diagnose and monitor myeloma. Tests on your blood will include:

  • Serum protein electrophoresis – This measures the amount of abnormal antibodies (paraproteins) in the blood. It is the main blood test used to diagnose myeloma.
  • Full blood count – This measures the levels of white blood cells, red blood cells and platelets in the blood. This test can show whether your bone marrow has been affected by myeloma.
  • Urea and electrolytes (U&E) test – This gives information about how well your kidneys are working.
  • Calcium level – This measures the level of calcium in the blood, as this can be raised in myeloma.
  • Beta-2 microglobulin level – This measures the level of a protein produced by myeloma cells. It shows how active the myeloma is.
  • Albumin level – This measures the level of albumin, which is a protein found in the blood. If this level is low, it can mean that a myeloma is advanced.
  • Serum free light chain assays (Freelite®) – This test can detect light chains in the blood. It is useful for diagnosing and monitoring light chain myeloma.
  • Erythrocyte sedimentation rate (ESR) – This test shows if red blood cells (erythrocytes) are sticking together more than usual. Paraproteins can cause this, so the ESR level may be higher if you have myeloma.


Urine tests

You may be asked to give urine samples to test for Bence Jones protein. These tests can also show how well your kidneys are working. 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.


Bone marrow biopsy

If there is a paraprotein in your blood or urine, a doctor or nurse will take a sample (biopsy) of bone marrow. The biopsy is usually taken from the back of your hipbone (pelvis), or sometimes the breast bone. The sample is sent to a laboratory to be checked under a microscope for abnormal cells.

Having a bone marrow biopsy
Having a bone marrow biopsy

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The procedure can be done on the ward or in the outpatients department and takes about 15–20 minutes. Removing the sample only takes a few minutes. Before the bone marrow sample is taken, you’ll be given a local anaesthetic injection to numb the area. You may be offered a short-acting sedative to make you more comfortable during the test.

The doctor or nurse passes a needle through your skin into the bone. They then draw a small sample of liquid from the bone marrow (a bone marrow aspirate) into a syringe. It can be uncomfortable for a few seconds when the marrow is drawn into the syringe.

You may also have a small core of marrow taken (a trephine biopsy). This procedure takes a few minutes longer. The doctor or nurse passes a thicker needle through the skin into the bone marrow. When they take the needle out, it contains a small core of bone marrow.

You may feel bruised after having a sample of bone marrow taken, and have an ache for a few days. You can take mild painkillers to ease this.

Cytogenetics

Each cell in the body contains chromosomes, which are made up of genes. Genes control all the cell’s activities. Some hospitals do tests on the bone marrow samples to look for chromosome changes. There may be changes in the chromosomes in the myeloma cells.

These tests are called cytogenetic tests. A test called fluorescence in situ hybridisation (FISH) may be used to look for any cytogenetic changes.

Knowing about these changes can help doctors to understand how the myeloma may behave and to plan treatment.


X-rays

X-rays will be taken to check for any damage to the bones from the myeloma cells (lytic lesions). You’ll usually have x-rays taken of the bones in your body that contain bone marrow. This is known as a skeletal survey and can take about 30–45 minutes. Although x-rays aren’t painful, you may find lying on a hard surface uncomfortable. Ask your doctor, nurse or radiographer for a painkiller if you need one.

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Further tests after diagnosis

Your doctor may suggest you have further tests, such as an MRI (magnetic resonance imaging) scan or a CT (computerised tomography) scan.