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Diagnosis

How Is Multiple Myeloma Diagnosed?

Physicians use several types of tests to diagnose multiple myeloma. However, signs of the disease are often discovered through routine medical testing, and certain tests are ordered to confirm the diagnosis.

A diagnostic work-up may include:

Personal and family medical history

Your doctor will likely ask you a series of questions relating to your personal medical history and your family's medical history.

Physical Exam

Your physician will ask you a series of questions and is likely to do a physical exam. The physical exam will including examining any specific areas of concern, especially as they relate to the reason for your visit to the office.

Multiple Myeloma Blood Tests

Doctors use several blood tests to check for multiple myeloma including blood count, quantitative immunoglobulins, SPEP, Beta-2 microglobulin, and blood chemistry tests.

Urine tests multiple myeloma

Doctors test the urine for a type of M protein called Bence Jones protein. Urine collected over a 24 hour period is sent to the lab to be examined. If the lab finds a high level of Bence Jones protein, doctors will monitor your kidneys, as too much Bence Jones protein can clog or damage the kidneys.

 

Physicians may perform one or more of the following imaging tests:

Bone x-rays

Bone x-rays are used to see damage to the bones caused by myeloma. Doctors will often take a series of x-rays that include most of the bones. This is called a bone survey or skeletal survey.

Computed Tomography (CT) Scan

CT scans use x-ray equipment and computer processing to produce 2-dimensional images of the body. The patient lies on a table and passes through a machine that looks like a large, squared-off donut. Doctors order CT scans when they want to see a two-dimensional image of the body to look for tumors and examine lymph nodes and bone abnormalities. If contrast dye is used to improve the computer image, the patient may need to avoid eating or drinking for 4 to 6 hours before the test. Patients should tell their provider before the test if they have any allergies or kidney problems.

Magnetic Resonance Imaging (MRI)

This test uses a magnetic field, radiofrequency pulses, and a computer to produce detailed images of body structures in multiple places. You may be asked to drink a contrast solution for better imaging, and you will most likely lie on a moving table as pictures are taken. MRI is a more detailed tool than x-ray and ultrasound and for certain organs or areas of the body, it provides better images than CT. MRI may not be recommended if you have a pacemaker or other metal implant.

Positron Emission Tomography (PET) scan

A PET scan is used to detect cellular reactions to sugar. Abnormal cells tend to react and "light up" on the scan, thus helping physicians diagnose a variety of conditions. For the PET scan, a harmless chemical, called a radiotracer, is injected into your blood stream. Once it has had time to move through your body, you will lie on a table while a scanner follows the radiotracer and sends three-dimensional images to a computer screen. Patients are generally asked to wear comfortable clothing and refrain from eating for 4 hours before the scan. Tell your doctor if you are pregnant or breastfeeding. Patients with diabetes should discuss diet guidelines with their physician for the hours leading up to the scan.

Bone marrow aspiration and biopsy

For a bone marrow aspiration (also called a bone marrow biopsy), the doctor uses a thick, hollow needle to remove a sample of bone marrow and bone marrow fluid.

Staging

Staging is the process of determining how extensive the cancer is. It is an important part of diagnosis because it is used to determine the most appropriate treatment options for patients.

To determine the stage of the disease, physicians may perform a number of tests, including blood tests, CT scans, and MRI scans.

Multiple myeloma ranges from Stage I to Stage III. The stage of the disease takes into account whether it is causing problems in the bones or kidneys or abnormalities in the blood counts or calcium levels.

Some patients have what physicians describe as “smoldering” myeloma. This means the disease is in its early stages, but no symptoms are present.

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