How multiple myeloma is diagnosed
To identify multiple myeloma, your doctor will look at any symptoms you may have and perform tests to look for signs ofmultiple myeloma throughout the body.
Signs and symptoms of multiple myeloma
The symptoms of multiple myeloma can vary from person to person. Some people have no symptoms at all.
According to the American Cancer Society, the most common multiple myeloma symptoms include:
- Bone pain that can be in any bone but is most often in your back, hips, and skull
- Bone weakness, either all over (osteoporosis) or where there is a bone tumor
- Broken bones or fractures, sometimes from minor stress or injury
- Anemia – low levels of red blood cells, which may cause weakness, fatigue, shortness of breath, and dizziness
- Leukopenia – low levels of white blood cells, which can increase the risk of infections and weaken the immune system
- Thrombocytopenia – low blood platelet counts, which may cause serious bleeding even with minor scrapes, cuts, or bruises
High levels of calcium in the blood, which can cause:
- Extreme thirst
- Excessive urination
- Kidney problems and even kidney failure
- Severe constipation
- Abdominal pain
- Loss of appetite
- Weakness and reduced ability to exercise, often associated with higher calcium levels and reduced red blood cells
- Multiple myeloma patients are much more likely to get infections. One example is pneumonia, which is a common infection often seen in myeloma patients that can be serious.
- This can make it harder for your body to remove excess salt, fluid, and body waste
This can lead to:
- Shortness of breath
- Leg swelling
This can cause:
- Sudden severe back pain
- Numbness or tingling in the hands and feet
- Muscle weakness, most often in the legs
Talk with your healthcare provider about any symptoms and questions you may have.
A diagnosis of multiple myeloma can be determined by several methods. These include blood and urine tests, imaging, and a bone marrow biopsy. Your doctor will decide which tests you need.
- To check for levels of different markers of multiple myeloma, including certain proteins and antibodies
Evidence of organ damage that could be caused by a plasma cell disorder, specifically:
- High levels of calcium in the blood
- High creatinine levels in the blood
- Anemia or low red blood cell count
- Plasma cell proteins in the blood
- Test results may help guide treatment decisions
Common imaging tests may include:
- MRI (magnetic resonance imaging)
- CT (computerized tomography) scans
- PET (positron emission tomography) scans
- An MRI may be used to check for severe bone loss, identified as 2 or more areas of bone or bone marrow damage
Your doctor may also use a bone marrow biopsy to look for:
- The presence of plasma cell tumors
- The amount of plasma cells in the bone marrow
Determining the stage of multiple myeloma to aid in treatment decisions
The most common way for a healthcare provider to determine the stage of a patient’s multiple myeloma is the Revised International Staging System (R-ISS), which is based on levels of 3 proteins and any genetic information in cancer cells:
Blood protein levels
- Albumin is the main protein found in blood plasma
- Beta-2-microglobulin is a protein made by many types of cells and can be found in the body
Lactate dehydrogenase (LDH) level
- Lactate dehydrogenase is a protein produced by many kinds of cells and can be found in body tissues
- Cytogenetics is a lab test that looks at changes to genetic information (DNA) in cancer cells
As multiple myeloma progresses, you may start to show symptoms or the cancer might start to impact other parts of your body. This is why early detection and effective treatment are important in managing the disease. Staging can be complex, so discuss your diagnosis with your doctor.
Questions to ask your doctor or nurse
It’s important to have open, honest discussions with your healthcare team. They want to answer your questions to help you make informed decisions. Here are a few questions to help you get started:
- What parts of the body can multiple myeloma affect?
- How advanced, or at what stage, is the multiple myeloma, and what should I do?
- Will I need other tests before we can make a treatment decision?
- Do you have an online portal for test results, appointments, and communications?
- How do I communicate with you in case of an emergency?
- How do we communicate for nonemergency interactions?
A multiple myeloma diagnosis can feel like a burden.Support groups can help you during your treatment journey.