Diagnosis of Multiple Myeloma
Early signs and symptoms of multiple myeloma (e.g., back pain, bone pain, chronic infection) often are vague and nonspecific; therefore, diagnosing the condition can be difficult. In some cases, multiple myeloma is diagnosed when x-rays are taken after an injury.
Multiple myeloma diagnosis involves taking a personal and family medical history and performing a complete physical examination and laboratory tests (e.g., blood tests, urine tests, imaging tests). Diagnosing multiple myeloma also involves ruling out other conditions (e.g., monoclonal gammopathy of unknown significance [MGUS], solitary plasmacytoma) and the earliest form of the disease (called smoldering myeloma).
A medical history includes information about the patient's family history of multiple myeloma and other types of cancer and personal history of radiation exposure. During the physical examination, the physician evaluates the patient for signs of bone pain and tenderness, masses (tumors), and swelling in the spleen, lymph nodes, and other organs.
Blood tests (e.g., complete blood count [CBC], erythrocyte sedimentation rate [ESR or sed rate]) are used to measure levels of red blood cells, white blood cells, platelets, proteins produced by abnormal plasma cells (e.g., M proteins, immunoglobulins [IgG, IgA]), and other substances (e.g., calcium, creatinine [Cr]) in the blood. Urine tests (e.g., 24-hour urine test) are used to measure protein and detect incomplete M proteins (called Bence Jones proteins or light chain proteins) in the urine.
Imaging tests can be used to detect lesions, rule out solitary tumors, and help diagnose multiple myeloma. These tests include chest and bone x-rays (radiographs), magnetic resonance imaging (MRI scan), and computed tomography (CT scan). An MRI scan uses electromagnetic radio waves to produce detailed images and detect tumors in bones and organs. In a CT scan, a series of x-rays is taken from many different angles and processed through a computer to produce cross-sectional images of structures in the body.
Multiple myeloma diagnosis also involves a bone marrow aspiration and biopsy. In this test, a needle is used to remove (aspirate) a sample of bone marrow, usually from the back of the hip bone. This tissue sample is then examined under a microscope to detect abnormal myeloma cells.