Myeloma is a rare type of cancer that initially has few or no symptoms. This means that a diagnosis can often be delayed.

Anyone who is suspected of having myeloma should be referred to a haematologist for further tests and investigations. Myeloma is a complex cancer and therefore its diagnosis can involve multiple tests. It is also a very individual cancer and therefore results from diagnostic tests may vary from patient to patient.

The aims of the tests and investigations are to

  • Establish a diagnosis
  • Gain an in-depth picture of the exact characteristics of your myeloma
  • Detect any problems so that they can be effectively managed
  • Help define a treatment plan

There are a variety of blood tests that help to diagnose and monitor myeloma. Regular blood tests are performed to measure your paraprotein level. As well as being important in diagnosing myeloma, changes in the paraprotein level can be a good indicator of changes in the activity of the myeloma. If no paraprotein is detected but myeloma is still suspected, a Freelite™ test may be performed to measure the amount of free light chains in your blood. This test is particularly important in diagnosing and monitoring light chain myeloma or non-secretory myeloma.

Full blood count

A full blood count measures the levels of the different cells in your blood. The most important are:

Red blood cell count (Haemoglobin) – a low count shows that you are anaemic

White blood cell counts – low counts of some or all of the different white blood cells indicate that you are at greater risk of infection

Platelet counts – a low count shows that you are at an increased risk of bleeding or bruising more easily than normal Blood chemistry

A full blood chemistry test provides an overview of the levels of various substances in your blood that can indicate the severity of the myeloma and myeloma-related complications. They include:

  • Beta 2 microglobulin (ß2M) – a protein that is found on the surface of almost all cells in the body. It is present in most body fluids but is increased in myeloma. ß2M is one of the most important indicators of both the amount and activity of myeloma the kidney and passed into the urine. High blood levels of creatinine and urea
  • Creatinine and urea – both are waste products that are normally filtered out by kidneys and can indicate poor kidney function
  • Albumin – a type of protein that normally makes up most of the protein found in the blood but in myeloma, chemical messengers (cytokines) produced by the myeloma cells suppress albumin production in the liver
  • Calcium –In patients with active myeloma bone disease, calcium is released from the bone into the blood leading to higher than normal levels (hypercalcaemia)

A skeletal survey is a series of X-rays of the long bones, spine and the skull, to detect the presence of and extent of any myeloma bone disease. Areas of bone damage that show up on an X-ray are known as lytic lesions. Skeletal surveys are the standard of care for detecting myeloma bone disease and are often one of the first tests to be carried out in the diagnosis of myeloma. The X-rays can also identify any areas of bone damage which have caused the bone to fracture or collapse and which require immediate repair.

If, there is any doubt with the results of the X-rays, you may be asked to undergo more detailed imaging scans such as a magnetic resonance imaging (MRI) or a computerised tomography (CT) scan of an area causing concern. These can provide more detail and identify areas of bone damage that are not so easily detected by X-ray.

A urine sample will be checked for the abnormal proteins produced by the cancerous plasma cells. The abnormal proteins are known as ‘monoclonal light chains’ and are sometimes referred to as Bence Jones protein.

These proteins can damage your kidneys as they pass through them from the blood to the urine. You may be asked to collect all of the urine you pass over a 24-hour period. This sample can be used to check the quantity of proteins being produced and how well your kidneys are functioning.

A bone marrow biopsy is used to confirm a diagnosis of myeloma.

A needle will be used to take a small sample of bone marrow (biopsy) from one of your bones, usually the pelvis. A sample of bone may also be removed. The procedure will be carried out using a local anaesthetic.

The sample of bone marrow (and bone) will be examined in a laboratory to check for the presence of cancerous plasma cells.