How is multiple myeloma found?
Multiple myeloma is hard to find early. Many patients don’t have any symptoms until after their disease has reached an advanced stage. In some patients, the cancer causes symptoms that at first seem to be caused by something else. Rarely, the disease may be found in people without symptoms when a routine blood test shows a high amount of protein in the blood.
Symptoms of multiple myeloma
While some people don’t have any symptoms at all, the following are the most common symptoms of this disease:
Normally, 2 kinds of bone cells work together to keep bones healthy and strong. Some cells lay down new bone; other cells break down old bone. Myeloma cells make a substance that causes the bone to dissolve, but the other cells do not get a signal to make new bone. So old bone is being broken down without new bone to replace it. This can cause small areas of bone weakness. The weak areas are often painful. These changes increase the risk of broken bones from minor stress or injury. Any bone can be involved, but pain in the backbone, hip bones, and skull is most common.
Low blood counts
When myeloma replaces normal blood-forming marrow cells, the bone marrow often does not make enough red blood cells, white blood cells, and blood platelets. Symptoms include:
- Low red blood cells (anemia): weakness, pale skin, not being able to exercise, shortness of breath, dizziness
- Low white blood cells: less able to fight infections
- Low platelet count: heavy bleeding from minor scrapes or cuts, or easy bruising
High blood calcium
When bone dissolves it can lead to high levels of calcium in the blood. This can cause kidney problems. It can also cause symptoms like feeling very thirsty, drinking a lot, and urinating (peeing) a lot. Other symptoms include loss of appetite, constipation, belly pain, and feeling sleepy or confused. If the problem isn’t treated, the person may go into a coma.
Nervous system symptoms
Bones in the spine may get weak and even collapse. They can press on certain nerves, causing pain, numbness, and/or muscle weakness. This, called spinal cord compression and is serious. You must contact your doctor right away or go to the emergency room if this happens.
Sometimes, the abnormal proteins made by myeloma cells can damage nerves, causing weakness and numbness. In some patients, a lot of this protein can make the blood “thicken.” This can slow blood flow to the brain and cause confusion, dizziness, and stroke-like symptoms. People with these symptoms should contact their doctor right away. Treatment works quickly. The doctor removes some of the protein from the blood using a treatment called plasmapheresis.
Too much myeloma protein or calcium in the blood can damage the kidneys. This makes it harder for the body to get rid of excess salt, fluid, and body waste products. People with this problem can feel weak and have shortness of breath, itching, and leg swelling.
Myeloma patients are much more likely to get infections. The most common and serious is pneumonia.
Tests for multiple myeloma
Lab tests on the blood or urine, x-rays of the bones, and a bone marrow biopsy are usually done if symptoms suggest that a person might have multiple myeloma.
Blood count: The complete blood count (CBC) is a test that measures the levels of red cells, white cells, and platelets in the blood. If myeloma cells take up too much of the bone marrow, some of these levels will be low. The most common finding is a low red blood cell count (anemia).
Quantitative immunoglobulins: This test measures the blood levels of the different antibodies called immunoglobulins. The levels of these are measured to see if any are too high or too low. In multiple myeloma, the level of one type may be high while the others are low. Many other tests can be done to measure antibodies, blood proteins, and urine proteins, too.
SPEP (serum protein electrophoresis): This test looks at the different proteins in the blood to see if the blood contains an abnormal myeloma protein. It is one of the first tests your doctor will order if myeloma is suspected.
Beta-2 microglobulin: The level of this protein is elevated in multiple myeloma. It is used to predict outlook and also to watch the results of treatment.
Blood chemistry tests: Tests will be done to check the level of different chemicals and electrolytes (like calcium, potassium, and sodium) in the blood.
Urine tests: You may be asked to collect all of your urine over a 24 hour period so that it can be checked for myeloma protein
Bone marrow biopsy: People with multiple myeloma have too many plasma cells in their bone marrow. The test to check the bone marrow is called a bone marrow biopsy. It can be either done at the doctor's office or at the hospital. A doctor will use a microscope to look at the bone marrow tissue to find out if there are myeloma cells in the bone marrow and, if so, how many.
For this test, the back of the hip bone is first numbed. Then a needle is used to remove some solid bone and some bone marrow. This causes a brief sharp pain, and there is some soreness in the biopsy area when the numbing medicine wears off. The biopsy can be done either at the doctor's office or at the hospital. Most patients can go home right after the test.
Other biopsy tests: In a fine needle aspiration (FNA) a very thin (fine) needle and a syringe are used to take out a small amount of tissue from a tumor or lymph node. The core needle biopsy is much like a FNA, but a larger needle is used and a larger tissue sample is removed. In multiple myeloma, these types of biopsies are most often used to check out abnormal areas that could be plasmacytomas.
Bone x-rays: Bone damage caused by the myeloma cells can be seen with x-rays. Often doctors will do a series of x-rays that includes most of the bones. This is called a bone survey or skeletal survey.
CT (CAT) scan: A CT scan is a special type of x-ray that takes many pictures of the body. A computer combines the x-rays to make detailed pictures. CT scans can help to tell if your bones have been damaged by myeloma. They can also be used to guide a biopsy needle into a tumor.
A CT scanner has been described as a large donut, with a narrow table in the middle “hole.” You will need to lie still on the table while the scan is being done. CT scans take longer than regular x-rays, and you might feel a bit confined by the ring while the pictures are being taken.
You might be asked to drink some liquid before the test. This helps outline the intestine so that it is not confused for tumors. Also, a kind of dye might be put into one of your veins. The dye helps to outline structures in the body. The dye can cause a feeling of warmth or flushing. Some people are allergic and get hives or other, more serious, reactions. Be sure to tell the doctor if you think you might be allergic to the dye. Also, tell the people doing the test that you have myeloma. Some of the dyes can damage the kidneys of people with myeloma.
CT scans take longer than regular x-rays. You will need to lie still on a table while they are being done. You might feel a bit confined by lying within the machine while the pictures are being taken. But CT scans are getting much faster and most only take a few minutes.
CT scans can also be used to guide a biopsy needle (see above) right into a something that might be a tumor.
MRI (magnetic resonance imaging): This test uses radio waves and strong magnets instead of x-rays to take pictures. A computer translates the pattern of radio waves into cross-sectional pictures of the body. MRI scans are very helpful in looking at bones, the brain, and the spinal cord. They may be able to find plasmacytomas that cannot be seen on regular x-rays. MRI scans can also be used to look at the bone marrow in patients with multiple myeloma. They take longer than CT scans. You will be inside a tube-like machine during the scan, which some people find upsetting. The machine also makes a thumping noise, but some places will give you earplugs with music to block this out. A dye (contrast material) might be used just as with CT scans but this is done less often.
PET scan (positron emission tomography): For a PET scan, a type of radioactive sugar (glucose) is put into one of your veins. Cancer cells absorb high amounts of this sugar. A special camera can then spot the radioactivity. When a patient appears to have a solitary plasmacytoma, a PET scan may be used to look for other plasmacytomas.
Putting it all together
No one test is enough to tell for sure if a person has multiple myeloma. Doctors look at all of these factors:
- Physical exam
- Results of blood tests, urine tests, and x-rays
- Results of biopsies
Last Medical Review: 02/01/2013
Last Revised: 02/13/2013