Tests for myeloma

Most people go to the GP when they first suspect they have a health problem. Your doctor will examine you and ask about your general health and medical history. The doctor will also ask you about your symptoms. This will include what they are, when you get them and whether anything you do makes them better or worse.

Your doctor may give you a physical examination to look for things such as bruising, bleeding or signs of infection. You will probably be asked to have some blood tests. You may also have a urine test to look for particular proteins.

If your doctor suspects that you may have multiple myeloma, they will arrange for you to see a haematologist at your local hospital. A haematologist is a medical doctor who specialises in diseases of the blood.

At the hospital, the haematologist will ask about your medical history and symptoms. They will examine you and arrange some more tests. You may have any or all of the following tests.

There are various blood tests that help to diagnose myeloma. One of the first tests your GP may have done is called an ESR. This stands for erythrocyte sedimentation rate (ESR). This test shows the doctor whether the red blood cells (erythrocytes) are sticking together, forming clumps. An abnormal ESR can be a sign of many illnesses or conditions, such as arthritis, infections and inflammation. But it can also be raised in myeloma, so an abnormal ESR may prompt your doctor to do further tests, particularly if there's no obvious reason for the ESR to be raised.

The main blood test to diagnose and monitor myeloma measures the type and amount of abnormal antibodies (paraproteins) produced by the plasma cells. This test is called serum protein electrophoresis or immunofixation because of the way the blood is tested in the lab. A small number of people with myeloma don't have paraproteins in their blood or urine. In these people a blood test called the serum free light chain test (Freelite) can help to diagnose the myeloma. The Freelite test picks up tiny amounts of small proteins called free light chains.

Your specialist will do a full blood count to check the levels of the different types of blood cells. Your GP may have already done this test, but it's likely to be repeated. If any of the blood cells are abnormal, this will be noted and reported back to your doctor. The doctor will be looking out for low numbers of red blood cells or platelets. Sometimes there are low numbers of the different types of white blood cells as well. 

You will have other blood tests to check that your liver and kidneys are working properly. Your doctor may also check your blood calcium level. The calcium level can be raised in myeloma, if the myeloma cells are in the hard outer covering of the bones.

This is sometimes called a bone marrow aspirate and biopsy. For this test, the doctor removes a sample of bone marrow cells (aspirate) to look at under the microscope. They may also remove a sample of bone (biopsy). There is detailed information about having a bone marrow test in the cancer tests section.

The bone marrow test is to see if there are any abnormal plasma cells in your bone marrow and how many there are. Your doctor may also do some tests called cytogenetics (pronounced sigh-toe gen-et-ics). These tests look for abnormalities in your chromosomes. In the laboratory, a scientist tests the cells from the bone marrow aspirate to see if there are any abnormal chromosomes. About 7 out of 10 people with myeloma (70%) have chromosome changes. Various research studies are looking into this. A few chromosome changes have been found that can affect how quickly the myeloma develops and how well treatment may work. Doctors may be able to use this information in the future to help decide which patients need more intensive treatment.

The large numbers of plasma cells being made in the bone marrow can cause damage to the hard outer covering of the bones. It will help your doctor to find this damage if you mention any bones that are painful. Your doctor will ask you to have X-rays of all your long bones, and your spine, pelvis and skull, to find any areas of damage. This is called a skeletal survey. Your doctor may also ask you to have a chest X-ray to check your general health.

The specialist will ask you for a urine sample. They will send the sample off to the lab, where a pathologist checks for the abnormal antibodies made by the cancerous plasma cells in multiple myeloma. Antibodies are proteins. Doctors call the abnormal antibodies 'monoclonal immunoglobulins' or paraproteins. Different types of myeloma make different paraproteins. One part of the paraprotein is the Bence Jones protein, which the body gets rid of in the urine.  About 3 out of 4 people (75%) with malignant myeloma have Bence Jones protein in their urine.

These protein molecules can damage the kidneys as they pass through them from the blood to the urine. Your doctor will check the levels of creatinine in your blood. Creatinine is another chemical that is removed from the body by your kidneys. If the levels of creatinine in your blood are high, this may mean your kidneys are not working properly.

Your nurse will probably ask you to collect all the urine you pass for 24 hours. This is the best way of finding out how much Bence Jones protein you are producing and also how well your kidneys are working.