Detection & Diagnosis of Multiple Myeloma

As with most other cancers, early detection is the main key to the successful treatment of multiple myeloma. However, because there are currently no recommended screening tests, it’s important to pay attention to possible signs and symptoms associated with the disease. 

Symptoms of Multiple Myeloma

Signs and symptoms associated with multiple myeloma can include: 

  • Frequent infections
  • Fatigue
  • Anemia
  • Bone pain 
  • Excessive thirst 
  • Weakness or numbness in the legs 

Keep in mind, however, that these symptoms can be attributed to something other than multiple myeloma. Still, it’s a good idea to have them checked by a doctor, especially if they don’t go away or get worse.

Doctors sometimes find multiple myeloma after a routine blood test. More often, doctors suspect multiple myeloma after an X-ray for a broken bone. Usually, though, patients go to the doctor because they are having other symptoms.

If you have any of the above symptoms that suggest multiple myeloma, your doctor will try to find out what’s causing the problem. Your doctor will first ask about your personal and family medical history. He or she will also perform a physical examination to check for signs of the disease or anything else that seems unusual. The doctor may also suggest other tests to make a diagnosis. 

Tests Used to Detect Multiple Myeloma 

Tests that may be used to diagnose multiple myeloma can include:

  • Blood tests and urine tests. Myeloma cells often secrete the antibody monoclonal immunoglobulin, known as M protein. The level of M proteins helps the doctor determine the extent of the disease and monitor how effective treatment is. Blood tests may also check for levels of blood creatinine, albumin, calcium, and other electrolytes that can indicate multiple myeloma. 
  • Bone marrow aspiration and biopsy: Because multiple myeloma causes too much plasma to be created in the bone marrow, doctors can remove some bone marrow and a small piece of bone to have it analyzed for signs of this cancer. The sample is usually taken through a needle inserted into the hipbone or breastbone. A biopsy is the only sure way to know whether myeloma cells are in your bone marrow. The genes in the myeloma are examined by cytogenetics and a special testing called fluorescent in situ hybridization (FISH). The aspirate (the liquid part of the bone marrow) may also be sent for other tests. 
  • Molecular testing of the tumor. Your doctor may recommend running laboratory tests on a tumor and/or bone marrow sample to identify specific chromosomes, genes, proteins, and other factors unique to the tumor. The results of these tests can influence the treatment you receive. 
    • Cytogenetics. Cytogenetics is the study of genetic changes in cells. In myeloma, the genes in plasma cells are routinely studied using the FISH test to identify standard and high-risk disease. 
    • Minimal residual disease (MRD). Minimal residual disease (MRD) refers to the small number of cancer cells that remain in the body after treatment. A negative result means that residual disease was not detected. An MRD positive test result means that residual (remaining) disease was detected and further treatment may be offered to suppress the disease further.
  • Bone X-rays. You may have X-rays to check for broken or thinning bones, since multiple myeloma affects your bone health. An X-ray of your whole body can be done to see how many bones could be damaged by the myeloma.
  • CT Scan. A procedure that makes a series of detailed pictures of areas inside the body, such as the neck, chest, abdomen, pelvis, and lymph nodes, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • MRI. A test that uses magnetic fields, not x-rays, to produce detailed images of the body. It can be used to measure the size of the tumor. A special dye called contrast medium is given intravenously before the scan to create a clearer picture. A radiologist interprets the scan.
  • PET scan (positron emission tomography scan). A procedure to find malignant (cancerous) tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
  • Fat pad aspirate. If certain M proteins that are misfolded in a particular way are deposited in body tissues, it can cause organs to stop functioning normally, resulting in a condition called amyloidosis. A biopsy performed on a sample of the abdominal fat pad (the collection of fat around a person's abdomen) may be necessary to determine if amyloidosis is present. 

Typically an oncologist will run several of these tests after your initial diagnosis. A medical oncologist will usually be the lead physician for the care of multiple myeloma patients. They will take the time to go over the results with you and discuss the specific subtype of myeloma as well as the stage. This information impacts the types and timing of cancer treatments.

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