Diagnosing Multiple Myeloma
Multiple myeloma is a type of blood cancer that occurs when plasma cells, which are a type of white blood cell, grow out of control in the bone marrow. The abnormal plasma can crowd out healthy blood cells in the bone marrow and form tumors in bones and soft tissues.
Specialists involved with diagnosing multiple myeloma include:
- Hematologists: These doctors diagnose and treat blood diseases, including bone marrow conditions.
- Medical oncologists: These doctors specialize in treating cancer.
- Pathologists: These doctors specialize in examining tissues to look for abnormalities, including cancer cells.
- Radiologists: These doctors specialize in examining images of the inside of the body, such as from X-rays and scans, to identify abnormalities that may be causing symptoms or a condition.
To diagnose multiple myeloma, doctors may perform several examinations, screening tests, and procedures. These include:
- Personal and family medical history: Doctors will ask about your symptoms, medical history, medications, and any family history of the condition.
- Physical examination: A thorough physical examination will be conducted to check for any signs or symptoms of multiple myeloma.
- Blood tests:
- Complete blood count (CBC): This test looks at the levels of different types of blood cells, including red blood cells, white blood cells, and platelets. In multiple myeloma, some blood cell counts may be low.
- Blood chemistry tests: These tests measure levels of electrolytes, minerals, and proteins in the blood, such as calcium, albumin, and creatinine. These tests provide information about overall health, including kidney and liver function. High calcium levels may be seen with multiple myeloma.
- Immunoglobulin tests: These tests measure the levels of different types of antibodies. These tests can detect abnormal proteins. In multiple myeloma, levels of one antibody type, M proteins, may be significantly higher than others.
- Urine tests: These measure the presence of abnormal proteins called M proteins in the urine and assess the clearance of creatinine, which is a measure of kidney function. High levels of M protein are seen with multiple myeloma. Multiple myeloma may reduce kidney function.
- Imaging tests: X-rays, MRIs, and PET scans can help evaluate bone damage and detect plasmacytoma tumors or other abnormalities caused by multiple myeloma.
- Bone marrow biopsy: This procedure involves taking a sample of bone marrow to examine for the presence of cancer cells. To make a diagnosis of multiple myeloma, the pathologist looks for the presence of plasma cell tumors or at least 10% plasma cells in the bone marrow.
After multiple myeloma is diagnoses, the healthcare provider will determine the classification and stage of disease. These are important considerations when planning treatment. Classification and staging include the following factors related to the progression of multiple myeloma in a person:
- Size of plasma cell tumors or bone lesions.
- Calcium levels in the blood.
- Hemoglobin levels for anemia.
- Serum creatinine levels as an indicator of kidney function.
- Serum and urinary M protein levels secreted by abnormal plasma cells.
The following are the classifications used for multiple myeloma:
- Monoclonal gammopathy of undetermined significance (MGUS): Monoclonal protein (M protein) is found in low amounts in the blood. About 2% of people with MGUS develop multiple myeloma.
- Solitary plasmacytomas: A single group or tumor of abnormal plasma cells is found.
- Smoldering multiple myeloma (SMM): Abnormal plasma cells are found in the bone marrow and M proteins are increase in the blood, but a person doesn’t experience symptoms. SMM is considered precancerous for multiple myeloma.
- Multiple myeloma: Multiple groups or tumors (plasmacytomas) of abnormal plasma cells are found, there is a high level of M protein in the blood or urine, and a high level of abnormal plasma cells in the bone marrow. People usually are symptomatic and have anemia, high blood calcium, kidney problems, and bone problems.
Multiple myeloma is then assigned a stage based on blood protein level indicators of how quickly multiple myeloma is growing.
- Stage 1 – Multiple myeloma is growing slowly
- Stage 2 – Multiple myeloma is growing more quickly
- Stage 3 – Multiple myeloma is aggressive and growing rapidly
Information about the presence of multiple myeloma, its classification, and its stage help doctors develop an appropriate treatment plan tailored to each individual's needs.