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Myeloma symptoms and diagnosis

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Myeloma tests for diagnosis

Initial screening tests

Your healthcare team will run tests to decide if you have MGUS, smouldering myeloma or symptomatic myeloma. If you have symptomatic myeloma you will begin treatment straight away.

A full blood count (FBC) is a simple blood test which measures the number of each type of cell in your blood, including plasma cells.

Most people with myeloma don’t have plasma cells in their blood, but if they do appear outside the bone marrow it may change your diagnosis to a related condition called plasma cell leukaemia. If this happens your doctor will talk about what this means for you.

An FBC will also check whether you have anaemia – a low level of haemoglobin (Hb) which is found in red blood cells. This is very common in myeloma and can make you feel tired and short of breath.

You might be sent for an FBC by your GP as part of a routine check-up. Other people might have one when they’re in hospital for something else.

You’ll have this test before diagnosis and throughout your treatment because an FBC can measure how your condition is responding to chemotherapy.

It’s worth staying aware of the results – this way you’ll know whether you’re responding well to treatment or if more needs to be done. It’s also very important to tell your healthcare team if you’ve experienced any new symptoms. They can then decide whether further testing or treatment is required.

This test looks at the amount and the type of paraprotein present in your blood and urine. It’s an important test which helps find out the type of myeloma you have and measures how you’re responding to treatment. If you have paraprotein present but you don’t have any other signs of myeloma then you may have MGUS.

This test is done to confirm a diagnosis of free light chain myeloma. You may have it if no paraprotein − or only a small amount − is found in your blood or urine. This sensitive test can detect even very small amounts of light chain proteins present.

This blood test checks that there’s not too much calcium being released into your blood because of myeloma-related damage to your bones.

This test defines the type of myeloma you have. Myeloma is classified according to the type of paraprotein your body is making, which may be IgG, IgA, IgM, IgD or IgE.

Although it’s rare, for some people with myeloma only light chains can be detected, not whole paraproteins. If there are only light chains, it’s known as free light chain myeloma. These light chains are known as either κ (kappa) or λ (lambda) type.

This test is used to determine how thick the blood is. Your doctor will take a blood sample to measure the rate at which the red blood cells settle at the bottom of a tube. This process should happen faster in people with more active myeloma, because of a higher amount of paraprotein in the blood.

This is a blood test to check how well your kidneys are working, and to see if there is any damage to your kidneys which may be caused by myeloma. It will help your doctors to calculate the doses of drugs you need. It can also show if you’re lacking fluid (dehydrated).

You’ll usually have your kidneys checked every time you have an appointment at the hospital.

This is a blood test to check if your liver is working normally. Chemotherapy drugs are broken down in the liver, so if the liver function test shows that your liver isn’t working properly, it may be necessary to adjust the dose of chemotherapy.

Further tests

You might have some further tests to either confirm the diagnosis, or to see how much the myeloma has developed and how much it’s affecting your body. These tests can also help you and your healthcare team decide which type of treatment would be best for you.

For many people this can be an anxious time, especially if you have to wait for the results. For emotional support and information, contact our Support Services Team.

This test is done to measure how thick the plasma is in the blood. It can show how active the myeloma is because thicker plasma is associated with more paraprotein in the blood.

If there’s paraprotein in your blood or urine, a biopsy will usually be taken from the bone marrow to confirm your diagnosis. It’s then studied under a microscope to see if there are any myeloma cells in it.

Find out more about bone marrow biopsies.

All kinds of cancer, including blood cancer, involve changes in genes in the affected cells. This isn’t the same as an inherited genetic cause (something that runs in families).

Understanding the exact changes in your myeloma cells can help doctors to diagnose your illness, decide how likely it is that your condition will respond to standard treatment, and monitor how well you respond to treatment. A sample from a bone marrow biopsy will be sent for FISH (fluorescence in situ hybridisation) testing. This test looks for gene changes in myeloma cells. Genetic tests that are even more sensitive are being introduced to give better information to guide treatment.

You'll also have a test to measure the levels of two proteins in the blood: albumin and B2 microglobulin or B2M (sometimes written as ß2M). B2M is a protein found on the surface of the myeloma cells. In myeloma, albumin levels can be low and B2M levels can be raised.

Staging the myeloma

Based on your B2M and albumin levels, the results of FISH and other genetic testing, and the level of a substance called lactate dehydrogenase (LDH) in your blood, doctors will decide if the myeloma is stage one (I), two (II) or three (III). This will give clearer information about your prognosis.

Scans

You may have a scan (CT, MRI or PET) to look for signs of myeloma in the bone marrow and check whether there is any evidence of bone damage.

Find out more about CT, MRI and PET scans.

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