Diagnosis often starts when someone sees their doctor for symptoms, such as fatigue, pain, or persistent infections. For others, abnormal test results during routine physical exams may prompt an investigation into blood disorders like multiple myeloma.
There are several noncancerous reasons with similar symptoms as multiple myeloma. Your doctor will ask about any symptoms, and family and medical history. A thorough physical exam will be done, which may include checking for swelling of the legs, or enlargement of the liver, spleen, or tongue. If there are no obvious reasons for these symptoms, a blood disorder may be suspected.
If you are having symptoms and your doctor suspects a blood disorder, tests can identify certain abnormalities. These may include:
Blood tests will help identify any abnormalities in the development or numbers of blood cells. Blood tests can include:
Other blood tests may be done to look for abnormalities caused by complications of multiple myeloma:
Urine tests may also help identify abnormal levels of certain proteins or calcium levels.
A bone marrow test is usually done to evaluate the blood cell counts and overall all health of the bone marrow. Blood stem cells are made in the bone marrow. If there are too many of one blood cell type, they may crowd out other blood cell types and interfere with their function.
A bone marrow aspiration removes a sample of bone marrow from the bone. In most cases, the sample is taken from the hipbone. A needle is inserted through the bone and the marrow is removed with a syringe. A piece of bone may also be removed for biopsy.
Both marrow and bone sample will be examined under a microscope to look for an abnormally high number of plasma cells, which indicate the presence of multiple myeloma.
A series of x-rays of all the body's bones may be done to look for fractures or other bone abnormalities. People with multiple myeloma may have bones with holes or other lesions that indicate the presence of disease. Bones examined include the skull, spine, pelvic area, ribs, and the long bones of the arms and legs.
A multiple myeloma diagnosis is made when either one of the following is present:
If multiple myeloma is confirmed, the results of the biopsy and new tests will help determine the stage of the cancer. Staging is used to identify characteristics of the cancer. Staging as well as other information like age and overall health will help develop the prognosis and treatment plan.
Staging is determined by a number of factors. Tests will vary by individual, but may include:
There are 2 different systems for staging multiple myeloma:
The Durie-Salmon staging system is used to stage multiple myeloma. The amount of cancer in the body is estimated based on the following factors:
Under normal circumstances, each substance in the blood or urine falls into a range that is considered normal. In people with multiple myeloma or other cancers, the substances may be too low or too high. Multiple myeloma is staged from I-III:
Multiple myeloma is staged I-III with the ISS. Cancer stage is based only on the blood levels of beta-2 microglobulin and albumin.
For treatment purposes, multiple myeloma may also be grouped as:
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Greipp PR, San Miguel J, Durie BG, et al. International staging system for multiple myeloma. J Clin Oncol. 2005;23(15):3412-3420.
How is multiple myeloma staged? American Cancer Society website. Available at: https://www.cancer.org/cancer/multiple-myeloma/detection-diagnosis-staging/staging.html. Updated January 19, 2016. Accessed March 16, 2017.
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Signs and symptoms of multiple myeloma. American Cancer Society website. Available at: https://www.cancer.org/cancer/multiple-myeloma/detection-diagnosis-staging/signs-symptoms.html. Updated January 19, 2016. Accessed March 16, 2017.
Multiple myeloma. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T116888/Multiple-myeloma. Updated November 21, 2016. Accessed March 16, 2017.
Myeloma staging. Leukemia & Lymphoma Society website. Available at: http://www.lls.org/disease-information/myeloma/diagnosis/myeloma-staging. Accessed March 16, 2017.
Stages of plasma cell neoplasms. National Cancer Institute website. Available at: https://www.cancer.gov/types/myeloma/patient/myeloma-treatment-pdq#section/_22. Updated August 5, 2016. Accessed March 16, 2017.
Last reviewed March 2017 by Mohei Abouzied, MD, FACP Last Updated: 5/12/2016