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Tests and diagnosis
By Mayo Clinic staffYour doctor may first detect signs of multiple myeloma before you even have symptoms — through blood and urine tests conducted during a routine physical exam. If you don't yet have symptoms, these lab tests may be repeated every few months so that your doctor can track whether your disease is progressing and determine the best time to start treatment.
Blood and urine tests
A blood test called serum protein electrophoresis separates your blood proteins and can detect the presence of monoclonal proteins (M proteins) — referred to as an "M spike" — in your blood. Parts of M proteins may also be detected in a test of your urine. When M proteins are found in urine, they're referred to as Bence Jones proteins. Monoclonal proteins may indicate multiple myeloma, but also can indicate other conditions.
If your doctor discovers M proteins, you'll likely need additional blood tests to measure blood cell counts and levels of calcium, uric acid and creatinine. Your doctor may also conduct other blood tests to check for beta-2-microglobulin — another protein produced by myeloma cells — or to measure the percent of plasma cells in your bone marrow.
Other tests
You may also need other tests. They may include:
- Imaging. X-rays of your skeleton can show whether your bones have any thinned-out areas, common in multiple myeloma. If a closer view of your bones is necessary, your doctor may use magnetic resonance imaging (MRI), computerized tomography (CT) scanning or positron emission tomography (PET) scanning.
- Bone marrow examination. Your doctor may also conduct a bone marrow examination by using a needle to remove a small sample of bone marrow tissue. The sample is then examined under a microscope to check for myeloma cells. A portion of the sample is also tested for chromosome abnormalities using tests such as fluorescence in situ hybridization (FISH). Tests are also done to measure the rate at which the plasma cells are dividing.
Staging and risk-stratification
These tests can help confirm whether you have multiple myeloma or another condition. If tests indicate you have multiple myeloma, the results from these tests allow your doctor to classify your disease as stage 1, stage 2 or stage 3. People with stage 3 myeloma are more likely to have one or more signs of advanced disease, including greater numbers of myeloma cells and kidney failure.
Although staging is useful in understanding how much myeloma is present in the body, doctors also need to know how aggressive the myeloma is. Your results from specialized bone marrow tests, such as FISH, will help your doctor determine your overall risk profile and develop the best treatment plan for you.
- Rajkumar SV, et al. Multiple myeloma and related disorders. In: Abeloff MD, et al. Abeloff's Clinical Oncology. 4th ed. Philadelphia, Pa.: Churchill Livingstone Elsevier; 2008. http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-0-443-06694-8..50114-7&isbn=978-0-443-06694-8&uniqId=265138448-3#4-u1.0-B978-0-443-06694-8..50114-7--cesec26. Accessed July 9, 2011.
- Mercier LR. Bone tumor, primary malignant.In: Ferri FF. Ferri's Clinical Advisor 2011: Instant Diagnosis and Treatment. Philadelphia, Pa.: Mosby Elsevier; 2011. http://www.mdconsult.com/books/about.do?eid=4-u1.0-B978-0-323-05610-6..C2009-0-38600-6--TOP&isbn=978-0-323-056106&about=true&uniqId=230100505-53. Accessed July 9, 2011.
- Rajkumar SV. Clinical features, laboratory manifestations, and diagnosis of multiple myeloma. http://www.uptodate.com/home/index.html. Accessed July 9, 2011.
- Kyle RA, et al. Multiple myeloma. In: Bope ET, et al. Conn's Current Therapy. Philadelphia, Pa.: Saunders Elsevier; 2011. http://www.mdconsult.com/books/about.do?eid=4-u1.0-B978-1-4377-0986-5..C2009-0-38984-9--TOP&isbn=978-1-4377-0986-5&about=true&uniqId=236797353-5. Accessed July 9, 2011.
- Rajkumar SV. Initial chemotherapy for patients with high risk multiple myeloma.http://www.uptodate.com/home/index.html. Accessed July 9, 2011.
- Thalidomide. National Cancer Insitute. http://www.cancer.gov/cancertopics/druginfo/thalidomide. Accessed July 9, 2011
- Rajkumar SV. Initial chemotherapy for symptomatic multiple myeloma in patients who are not candidates for transplantation. http://www.uptodate.com/home/index.html. Accessed July 9, 2011.
- Rajkumar SV. Treatment of the complications of multiple myeloma. http://www.uptodate.com/home/index.html. Accessed July 9, 2011.
- Multiple myeloma: Lifestyle changes to consider during and after treatment. American Cancer Society. http://www.cancer.org/Cancer/MultipleMyeloma/DetailedGuide/multiple-myeloma-after-lifestyle-changes. Accessed July 9, 2011.
- Multiple myeloma: How about your emotional health? American Cancer Society. http://www.cancer.org/Cancer/MultipleMyeloma/DetailedGuide/multiple-myeloma-after-emotional-health. Accessed July 9, 2011.
- Complementary and alternative methods for cancer management. American Cancer Society. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/complementary-and-alternative-methods-for-cancer-management. Accessed July 9, 2011.
- Lu Weidong, et al. The value of acupuncture in cancer care. Hematology/Oncology Clinics of North America. 2008;22:631.
- Rajkumar SV (expert opinion). Mayo Clinic, Rochester, Minn. July 25, 2011.
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